- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $1,122.02
| Facility | | $112.20 | $154.88 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $691.83 / $1,862.09 / $2,884.03
| Facility | 25 | $691.83 | $1,862.09 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $851.14
| Professional | | $89.13 | $151.36 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $117.49 / $426.58 / $1,862.09
| Professional | 25 | $117.49 | $426.58 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $109.65 / $190.55
| Professional | | $89.13 | $109.65 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $97.72 / $141.25 / $190.55
| Professional | 25 | $97.72 | $141.25 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $1,584.89
| Facility | | $158.49 | $158.49 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $169.82 / $169.82
| Professional | | $151.36 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $138.04 / $208.93
| Facility | | $100.00 | $138.04 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $151.36 / $269.15
| Professional | | $112.20 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $128.82 / $281.84
| Professional | | $95.50 | $128.82 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $154.88 / $1,122.02
| Facility | | $112.20 | $154.88 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $691.83 / $851.14 / $2,884.03
| Facility | 25 | $691.83 | $851.14 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $144.54 / $446.68
| Professional | | $91.20 | $144.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $125.89 / $389.05 / $1,380.38
| Professional | 25 | $125.89 | $389.05 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $120.23 / $204.17
| Professional | | $89.13 | $120.23 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $100.00 / $251.19
| Facility | | $91.20 | $100.00 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $128.82 / $245.47
| Professional | | $100.00 | $128.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $134.90 / $257.04
| Professional | 25 | $79.43 | $134.90 | $257.04 |