- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $213.80 / $436.52
| Facility | | $87.10 | $213.80 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Facility | 25 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.95 / $54.95
| Professional | | $7.08 | $19.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $31.62 / $79.43
| Professional | 25 | $16.98 | $31.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $22.39 / $27.54
| Professional | | $13.80 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $24.55 / $29.51
| Professional | 25 | $19.05 | $24.55 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $18.62 / $38.90
| Professional | | $8.51 | $18.62 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $128.82 / $194.98
| Facility | | $30.20 | $128.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.95 / $34.67
| Professional | | $8.71 | $19.95 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $16.98 / $33.88
| Professional | | $0.18 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $83.18
| Professional | 25 | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $11.48 / $36.31
| Professional | | $0.18 | $11.48 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $22.39 / $25.70
| Professional | | $7.59 | $22.39 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $48.98 / $154.88
| Facility | | $33.11 | $48.98 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.50 / $39.81
| Professional | | $8.71 | $19.50 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | 25 | $28.84 | $28.84 | $28.84 |