- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $512.86 / $776.25
| Facility | | $95.50 | $512.86 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $776.25 / $1,000.00 / $6,025.60
| Facility | 25 | $776.25 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $794.33
| Professional | | $89.13 | $154.88 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $338.84 / $1,318.26
| Professional | 25 | $114.82 | $338.84 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $1,348.96
| Facility | | $616.60 | $616.60 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $288.40 / $371.54
| Professional | | $181.97 | $288.40 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $229.09 / $295.12
| Professional | 25 | $144.54 | $229.09 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $380.19 / $1,047.13
| Facility | | $245.47 | $380.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $128.82 / $269.15 / $446.68
| Professional | | $128.82 | $269.15 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $416.87 / $812.83
| Facility | | $239.88 | $416.87 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $281.84 / $416.87
| Professional | | $181.97 | $281.84 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $154.88 / $316.23
| Facility | | $93.33 | $154.88 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $741.31
| Facility | 25 | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $302.00 / $1,174.90
| Professional | | $125.89 | $302.00 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $257.04 / $331.13 / $562.34
| Professional | 25 | $257.04 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $218.78 / $371.54
| Professional | | $112.20 | $218.78 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $234.42
| Professional | 25 | $79.43 | $89.13 | $234.42 |