- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $100.00 / $257.04
| Facility | | $15.85 | $100.00 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $56.23 / $239.88 / $331.13
| Facility | 25 | $56.23 | $239.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $20.89 / $51.29
| Professional | | $7.08 | $20.89 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $56.23
| Professional | 25 | $16.98 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $15.85 / $128.82
| Facility | | $6.92 | $15.85 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $32.36 / $64.57
| Professional | | $13.80 | $32.36 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.96 / $25.70 / $52.48
| Professional | 25 | $10.96 | $25.70 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $208.93
| Facility | | $51.29 | $81.28 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $30.20 / $77.62
| Professional | | $14.13 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $85.11 / $165.96
| Facility | | $54.95 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $33.88 / $77.62
| Professional | | $14.79 | $33.88 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $21.38 / $46.77
| Facility | | $8.13 | $21.38 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | 25 | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $58.88 / $93.33
| Professional | | $24.55 | $58.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $56.23 / $77.62
| Professional | 25 | $44.67 | $56.23 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $48.98
| Facility | | $28.18 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $29.51 / $63.10
| Professional | | $10.96 | $29.51 | $63.10 |