- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $501.19 / $2,290.87
| Facility | | $177.83 | $501.19 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $891.25 / $2,041.74 / $3,019.95
| Facility | 25 | $891.25 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $269.15 / $812.83
| Professional | | $173.78 | $269.15 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $190.55 / $354.81 / $954.99
| Professional | 25 | $190.55 | $354.81 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $204.17 / $354.81
| Professional | | $186.21 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $169.82 / $204.17 / $457.09
| Professional | 25 | $169.82 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,187.76 / $2,454.71 / $2,454.71
| Facility | | $2,187.76 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $549.54
| Professional | | $213.80 | $263.03 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $389.05
| Professional | | $309.03 | $309.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $1,995.26 / $11,481.54
| Facility | | $331.13 | $1,995.26 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $338.84 / $724.44
| Professional | | $204.17 | $338.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $128.82 / $512.86
| Facility | | $128.82 | $128.82 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $457.09 / $691.83
| Professional | | $346.74 | $457.09 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Facility | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $575.44
| Professional | | $218.78 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $251.19
| Professional | 25 | $245.47 | $245.47 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $2,290.87 / $2,344.23
| Facility | | $1,862.09 | $2,290.87 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $2,041.74 / $2,290.87 / $2,290.87
| Facility | 25 | $2,041.74 | $2,290.87 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $549.54
| Professional | | $288.40 | $354.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $295.12 / $346.74 / $660.69
| Professional | 25 | $295.12 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $389.05 / $724.44
| Professional | | $316.23 | $389.05 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $2,290.87 / $10,964.78
| Facility | | $239.88 | $2,290.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $977.24
| Professional | | $223.87 | $446.68 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $87.10 / $295.12 / $436.52
| Professional | 25 | $87.10 | $295.12 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Facility | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $316.23 / $549.54
| Professional | | $223.87 | $316.23 | $549.54 |