- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $114.82 / $630.96 / $1,348.96
| Facility | | $114.82 | $630.96 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $501.19 / $630.96 / $676.08
| Facility | 25 | $501.19 | $630.96 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $147.91 / $851.14
| Professional | | $89.13 | $147.91 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $107.15 / $426.58 / $2,238.72
| Professional | 25 | $107.15 | $426.58 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $147.91 / $245.47
| Professional | | $107.15 | $147.91 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $123.03 / $218.78
| Professional | | $117.49 | $123.03 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $5,495.41
| Facility | | $165.96 | $165.96 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $134.90 / $229.09
| Professional | | $102.33 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $151.36 / $223.87
| Professional | | $117.49 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $138.04 / $223.87
| Professional | | $112.20 | $138.04 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $223.87
| Facility | | $97.72 | $144.54 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $234.42
| Professional | | $89.13 | $89.13 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $128.82 / $204.17
| Facility | | $109.65 | $128.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $120.23 / $141.25 / $229.09
| Professional | | $120.23 | $141.25 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $89.13
| Facility | | $81.28 | $81.28 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $218.78
| Professional | | $89.13 | $128.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $87.10 / $234.42
| Professional | 25 | $79.43 | $87.10 | $234.42 |