- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $20.89 / $109.65
| Facility | | $8.13 | $20.89 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $70.79 / $87.10 / $87.10
| Facility | 25 | $70.79 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.95 / $43.65
| Professional | | $7.08 | $19.95 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $69.18
| Professional | 25 | $19.50 | $33.11 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $21.38 / $40.74
| Professional | | $9.12 | $21.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $7.24 / $12.88
| Professional | | $6.17 | $7.24 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $141.25 / $204.17
| Facility | | $27.54 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $21.38 / $36.31
| Professional | | $9.33 | $21.38 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $28.18 / $41.69
| Professional | | $11.48 | $28.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.99 / $31.62
| Professional | | $19.50 | $23.99 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $20.42 / $36.31
| Facility | | $8.32 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $25.12 / $50.12
| Professional | | $7.59 | $25.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $10.96 / $19.50
| Facility | | $8.71 | $10.96 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.70 / $42.66
| Professional | | $19.95 | $25.70 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $14.79 / $27.54
| Facility | | $6.92 | $14.79 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $18.62 / $38.02
| Professional | | $7.94 | $18.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.99 / $24.55 / $79.43
| Professional | 25 | $23.99 | $24.55 | $79.43 |