- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $169.82
| Facility | | $15.85 | $21.38 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $34.67 / $158.49 / $208.93
| Facility | 25 | $34.67 | $158.49 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.05 / $39.81
| Professional | | $7.08 | $19.05 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $48.98
| Professional | 25 | $20.42 | $33.11 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $9.77 / $13.80
| Facility | | $8.13 | $9.77 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $22.91 / $48.98
| Professional | | $20.42 | $22.91 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $134.90
| Facility | | $27.54 | $27.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $20.89 / $72.44
| Professional | | $8.32 | $20.89 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $25.70 / $26.92
| Professional | | $9.33 | $25.70 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $22.91 / $25.12 / $25.70
| Professional | 25 | $22.91 | $25.12 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $16.98 / $33.11
| Professional | | $7.59 | $16.98 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $79.43
| Professional | 25 | $23.99 | $28.84 | $79.43 |