- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $354.81 / $1,000.00
| Facility | | $147.91 | $354.81 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | 25 | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $177.83 / $912.01
| Professional | | $91.20 | $177.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $109.65 / $426.58 / $1,479.11
| Professional | 25 | $109.65 | $426.58 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $117.49 / $309.03
| Professional | | $114.82 | $117.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | 25 | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $6,025.60 / $10,964.78
| Facility | | $5,370.32 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $177.83 / $245.47
| Professional | | $134.90 | $177.83 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12,022.64 / $12,022.64 / $15,488.17
| Facility | | $12,022.64 | $12,022.64 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $169.82 / $269.15
| Professional | | $109.65 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $186.21 / $323.59
| Professional | | $123.03 | $186.21 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $181.97 / $331.13
| Professional | | $120.23 | $181.97 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $257.04
| Professional | 25 | $79.43 | $89.13 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $44.67 / $48.98
| Facility | | $39.81 | $44.67 | $48.98 |