- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $26.92 / $478.63
| Facility | | $13.18 | $26.92 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $371.54
| Facility | 25 | $245.47 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.05 / $36.31
| Professional | | $7.08 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $46.77
| Professional | 25 | $16.98 | $28.18 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $21.88 / $30.20
| Professional | | $8.32 | $21.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.78 / $23.44 / $30.90
| Professional | 25 | $17.78 | $23.44 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.60 / $28.84
| Professional | | $8.71 | $16.60 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $144.54
| Facility | | $100.00 | $120.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $20.42 / $30.20
| Professional | | $8.71 | $20.42 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $19.50 / $33.88
| Facility | | $7.24 | $19.50 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $489.78
| Professional | | $18.62 | $26.30 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | 25 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.05 / $34.67
| Facility | | $9.12 | $19.05 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $17.78 / $29.51
| Professional | | $8.13 | $17.78 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $24.55 / $85.11 / $85.11
| Professional | 25 | $24.55 | $85.11 | $85.11 |