- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $29.51 / $35.48
| Facility | | $13.49 | $29.51 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $102.33
| Facility | 25 | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $18.20 / $32.36
| Professional | | $10.72 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.38 / $23.99 / $42.66
| Professional | 25 | $17.38 | $23.99 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $21.88
| Professional | | $10.72 | $14.45 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $19.95
| Professional | 25 | $10.72 | $14.45 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $134.90 / $134.90
| Facility | | $33.88 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.85 / $25.12
| Professional | | $10.96 | $15.85 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $17.38
| Facility | | $10.96 | $13.80 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $15.85 / $20.89
| Professional | | $13.18 | $15.85 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.18 / $22.91
| Facility | | $10.72 | $13.18 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $26.30
| Professional | | $11.22 | $15.14 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.88 / $18.20
| Facility | | $9.55 | $12.88 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $20.89
| Professional | | $10.96 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $79.43 / $95.50
| Professional | 25 | $16.98 | $79.43 | $95.50 |