- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $12.88
| Facility | | $10.00 | $10.00 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $16.98 / $32.36
| Professional | | $10.47 | $16.98 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $14.13 / $26.30 / $37.15
| Professional | 25 | $14.13 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $19.95
| Professional | | $10.72 | $14.79 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $21.38
| Professional | 25 | $10.72 | $14.45 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.13 / $17.78
| Professional | | $9.77 | $14.13 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.14 / $29.51
| Professional | | $10.96 | $15.14 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $10.23 / $18.20
| Facility | | $10.23 | $10.23 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $12.88 / $20.42
| Professional | | $9.33 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $95.50
| Professional | 25 | $79.43 | $79.43 | $95.50 |