- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $44.67 / $162.18
| Facility | | $22.91 | $44.67 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $83.18
| Professional | | $13.80 | $32.36 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $141.25
| Professional | 25 | $19.95 | $26.30 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $52.48 / $95.50
| Facility | | $29.51 | $52.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $28.84
| Professional | | $21.88 | $27.54 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $22.91 / $43.65
| Professional | | $15.85 | $22.91 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.30 / $52.48
| Facility | | $14.45 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $26.30 / $63.10
| Professional | | $15.49 | $26.30 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.95 / $26.30 / $141.25
| Professional | 25 | $19.95 | $26.30 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.38 / $32.36
| Professional | | $18.20 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.79 / $33.11
| Professional | | $14.45 | $14.79 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $24.55 / $35.48
| Professional | | $17.38 | $24.55 | $35.48 |