- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $36.31 / $36.31
| Facility | | $12.02 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $10.00 / $38.90
| Professional | | $3.98 | $10.00 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $8.32 / $10.47 / $14.13
| Professional | 25 | $8.32 | $10.47 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $6.46 / $12.88
| Professional | | $3.02 | $6.46 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.90 / $13.49
| Professional | | $3.63 | $4.90 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $6.03 / $11.75
| Facility | | $4.07 | $6.03 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $10.00 / $29.51
| Professional | | $5.01 | $10.00 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $10.72 / $12.59
| Professional | | $9.55 | $10.72 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $12.59
| Professional | | $5.89 | $5.89 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $36.31
| Facility | | $35.48 | $35.48 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $8.51 / $11.48
| Professional | | $4.79 | $8.51 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $7.76 / $13.80
| Professional | | $4.90 | $7.76 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.59 / $8.91
| Professional | | $7.08 | $7.59 | $8.91 |