- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $288.40 / $912.01
| Facility | | $18.62 | $288.40 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $467.74 / $977.24
| Facility | 25 | $100.00 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.05 / $42.66
| Professional | | $7.08 | $19.05 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $18.20 / $30.20 / $56.23
| Professional | 25 | $18.20 | $30.20 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $22.39 / $50.12
| Professional | | $8.91 | $22.39 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $23.44 / $63.10
| Facility | | $8.91 | $23.44 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $100.00 / $467.74 / $977.24
| Facility | 25 | $100.00 | $467.74 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $25.12 / $75.86
| Professional | | $10.47 | $25.12 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $34.67 / $85.11
| Professional | 25 | $19.05 | $34.67 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $3,467.37
| Facility | | $21.38 | $21.38 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $45.71 / $61.66
| Professional | | $21.38 | $45.71 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $21.88 / $41.69
| Facility | | $8.51 | $21.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $23.99 / $66.07
| Professional | | $11.22 | $23.99 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $25.70 / $69.18
| Professional | | $7.76 | $25.70 | $69.18 |