- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $117.49 / $467.74
| Facility | | $69.18 | $117.49 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $537.03 / $660.69 / $660.69
| Facility | 25 | $537.03 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $123.03 / $741.31
| Professional | | $87.10 | $123.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $123.03 / $416.87 / $1,698.24
| Professional | 25 | $123.03 | $416.87 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $109.65 / $162.18
| Professional | | $85.11 | $109.65 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $112.20 / $204.17
| Professional | 25 | $95.50 | $112.20 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $302.00 / $302.00
| Facility | | $288.40 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $162.18 / $177.83
| Professional | | $151.36 | $162.18 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $234.42
| Professional | | $100.00 | $141.25 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $275.42
| Facility | | $91.20 | $123.03 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $1,174.90
| Professional | | $120.23 | $181.97 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Facility | | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $131.83 / $186.21
| Professional | | $107.15 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $144.54
| Professional | 25 | $79.43 | $79.43 | $144.54 |