- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $19.50 / $93.33
| Facility | | $6.61 | $19.50 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $204.17
| Facility | 25 | $66.07 | $97.72 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.76 / $18.62 / $37.15
| Professional | | $6.76 | $18.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $69.18
| Professional | 25 | $19.50 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.41 / $20.89 / $31.62
| Professional | | $7.41 | $20.89 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $14.45 / $21.88 / $44.67
| Professional | 25 | $14.45 | $21.88 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $42.66 / $42.66
| Facility | | $40.74 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.49 / $29.51
| Professional | | $11.48 | $13.49 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $151.36 / $190.55
| Facility | | $28.18 | $151.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.42 / $33.88
| Professional | | $9.12 | $20.42 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $19.50 / $30.20
| Facility | | $7.59 | $19.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $489.78
| Professional | | $20.42 | $29.51 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $48.98
| Facility | | $20.42 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $19.95 / $32.36
| Professional | | $9.33 | $19.95 | $32.36 |