- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $501.19 / $1,698.24
| Facility | | $12.88 | $501.19 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $74.13
| Professional | | $12.88 | $25.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.00 / $46.77 / $141.25
| Professional | 25 | $10.00 | $46.77 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $21.38
| Professional | | $12.02 | $14.79 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $23.44 / $38.02
| Facility | | $12.88 | $23.44 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $22.39
| Professional | | $12.88 | $15.85 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $22.39 / $46.77
| Professional | | $13.80 | $22.39 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $25.70
| Facility | | $16.98 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $11.75 / $27.54
| Professional | | $8.51 | $11.75 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $29.51 / $33.11
| Professional | | $13.18 | $29.51 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $19.95 / $38.02
| Professional | | $12.88 | $19.95 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $15.85
| Professional | | $10.96 | $10.96 | $15.85 |