- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $69.18 / $117.49
| Facility | | $15.85 | $69.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $134.90
| Facility | 25 | $70.79 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.05 / $33.88
| Professional | | $7.08 | $19.05 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $50.12
| Professional | 25 | $17.78 | $28.18 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $21.88 / $31.62
| Professional | | $7.94 | $21.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $50.12
| Professional | 25 | $17.78 | $22.39 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $128.82
| Facility | | $11.22 | $11.22 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $22.91
| Professional | | $19.95 | $19.95 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $125.89 / $141.25
| Facility | | $109.65 | $125.89 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $19.05 / $30.90
| Professional | | $8.91 | $19.05 | $30.90 |
- 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
- $6.03 / $12.88 / $28.18
| Facility | | $6.03 | $12.88 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $18.20 / $29.51
| Professional | | $7.94 | $18.20 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | 25 | $28.84 | $28.84 | $28.84 |