- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $60.26 / $134.90
| Facility | | $15.49 | $60.26 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $57.54 / $123.03 / $269.15
| Facility | 25 | $57.54 | $123.03 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.95 / $51.29
| Professional | | $7.08 | $19.95 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $46.77 / $95.50
| Professional | 25 | $16.98 | $46.77 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $58.88
| Professional | | $21.38 | $26.92 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $20.89 / $24.55 / $33.88
| Professional | 25 | $20.89 | $24.55 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $173.78
| Facility | | $109.65 | $109.65 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $21.88 / $39.81
| Professional | | $12.02 | $21.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $173.78 / $199.53
| Facility | | $151.36 | $173.78 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $23.44 / $45.71
| Professional | | $10.23 | $23.44 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $25.12 / $56.23
| Professional | | $9.55 | $25.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $43.65 / $75.86
| Professional | | $24.55 | $43.65 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Facility | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $29.51 / $61.66
| Professional | | $12.02 | $29.51 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $16.98 / $26.30
| Facility | | $15.49 | $16.98 | $26.30 |