- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $338.84
| Facility | | $16.98 | $25.70 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $85.11
| Professional | | $12.59 | $25.70 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $22.91 / $51.29 / $141.25
| Professional | 25 | $22.91 | $51.29 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $15.14 / $21.38
| Professional | | $12.02 | $15.14 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $109.65 / $407.38
| Facility | | $54.95 | $109.65 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.20 / $31.62
| Professional | | $16.22 | $30.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $23.99 / $42.66
| Professional | | $15.14 | $23.99 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $102.33
| Professional | | $14.45 | $26.92 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $17.38 / $19.05
| Professional | | $16.98 | $17.38 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $23.99
| Facility | | $13.80 | $13.80 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $24.55 / $40.74
| Professional | | $15.85 | $24.55 | $40.74 |