- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $63.10
| Facility | | $10.96 | $16.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $16.98 / $34.67
| Professional | | $10.72 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.60 / $28.84 / $52.48
| Professional | 25 | $16.60 | $28.84 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $57.54 / $154.88
| Facility | | $9.33 | $57.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $43.65
| Professional | | $18.20 | $30.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $14.45 / $25.12 / $34.67
| Professional | 25 | $14.45 | $25.12 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $46.77 / $128.82
| Facility | | $31.62 | $46.77 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $29.51 / $50.12
| Professional | | $14.45 | $29.51 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $50.12 / $100.00
| Facility | | $33.11 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.84 / $45.71
| Professional | | $19.50 | $28.84 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $33.88
| Facility | | $10.96 | $17.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $29.51 / $67.61
| Professional | | $14.13 | $29.51 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $58.88
| Professional | 25 | $25.12 | $53.70 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.44 / $39.81
| Professional | | $12.59 | $23.44 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $30.20 / $79.43 / $95.50
| Professional | 25 | $30.20 | $79.43 | $95.50 |