- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $194.98 / $512.86
| Facility | | $87.10 | $194.98 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $489.78 / $630.96 / $3,890.45
| Facility | 25 | $489.78 | $630.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $154.88 / $724.44
| Professional | | $89.13 | $154.88 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $302.00 / $1,380.38
| Professional | 25 | $104.71 | $302.00 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $177.83
| Professional | | $97.72 | $117.49 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $177.83
| Professional | 25 | $102.33 | $131.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,620.87 / $18,620.87 / $21,877.62
| Facility | | $18,620.87 | $18,620.87 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $120.23 / $208.93
| Professional | | $114.82 | $120.23 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $123.03 / $204.17
| Professional | | $120.23 | $123.03 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $3,715.35
| Facility | | $165.96 | $165.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $134.90 / $234.42
| Professional | | $100.00 | $134.90 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $204.17 / $288.40
| Professional | | $138.04 | $204.17 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $147.91 / $239.88
| Professional | | $109.65 | $147.91 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | 25 | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $1,047.13
| Professional | | $123.03 | $144.54 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $114.82 / $123.03 / $229.09
| Professional | 25 | $114.82 | $123.03 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18,620.87 / $18,620.87 / $21,877.62
| Facility | | $18,620.87 | $18,620.87 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $120.23 / $208.93
| Professional | | $114.82 | $120.23 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $95.50 / $263.03
| Facility | | $85.11 | $95.50 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $269.15
| Professional | | $89.13 | $128.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $8,128.31
| Facility | | $120.23 | $120.23 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $213.80 / $263.03
| Professional | | $120.23 | $213.80 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $107.15 / $186.21
| Professional | | $38.02 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $125.89 / $223.87
| Professional | | $93.33 | $125.89 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $89.13 / $234.42
| Professional | 25 | $79.43 | $89.13 | $234.42 |