- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $1,548.82 / $10,232.93
| Facility | | $138.04 | $1,548.82 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $870.96 / $3,548.13 / $23,988.33
| Facility | 25 | $870.96 | $3,548.13 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $181.97 / $794.33
| Professional | | $95.50 | $181.97 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $107.15 / $363.08 / $1,445.44
| Professional | 25 | $107.15 | $363.08 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $125.89 / $295.12
| Professional | | $97.72 | $125.89 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $245.47
| Professional | 25 | $97.72 | $120.23 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $162.18 / $776.25
| Facility | | $131.83 | $162.18 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $158.49 / $288.40
| Professional | | $109.65 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $194.98 / $363.08
| Professional | | $128.82 | $194.98 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,890.45 / $5,128.61 / $5,128.61
| Facility | | $3,890.45 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $144.54 / $263.03
| Professional | | $104.71 | $144.54 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $109.65 / $190.55
| Professional | | $58.88 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $245.47
| Professional | | $100.00 | $138.04 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $1,174.90 / $1,174.90
| Professional | | $128.82 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $173.78
| Professional | | $32.36 | $33.11 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $229.09
| Facility | | $97.72 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $151.36 / $295.12
| Professional | | $107.15 | $151.36 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $316.23
| Professional | | $288.40 | $288.40 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $100.00 / $144.54
| Professional | | $58.88 | $100.00 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $123.03 / $245.47
| Professional | | $89.13 | $123.03 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $186.21
| Professional | 25 | $85.11 | $85.11 | $186.21 |