- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.49 / $36.31
| Facility | | $10.00 | $15.49 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | 25 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $16.98 / $30.90
| Professional | | $10.72 | $16.98 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $13.80 / $23.44 / $50.12
| Professional | 25 | $13.80 | $23.44 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $13.49 / $18.62
| Professional | | $10.72 | $13.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $19.50
| Professional | 25 | $10.72 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $16.98
| Professional | | $10.96 | $13.18 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $18.20
| Facility | | $10.23 | $12.59 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $15.49 / $20.89
| Professional | | $12.30 | $15.49 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $18.20 / $18.20
| Facility | | $12.59 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $67.61
| Professional | | $11.22 | $15.85 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $11.22 / $33.11
| Professional | | $7.24 | $11.22 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $18.20
| Facility | | $14.45 | $14.45 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.80 / $20.89
| Professional | | $10.47 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 25 | $95.50 | $95.50 | $95.50 |