- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $17.78 / $52.48
| Facility | | $10.47 | $17.78 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $30.20
| Professional | | $10.00 | $15.14 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $12.88 / $21.88 / $33.11
| Professional | 25 | $12.88 | $21.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $14.45 / $20.42
| Professional | | $10.96 | $14.45 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $12.02 / $15.85 / $23.99
| Professional | 25 | $12.02 | $15.85 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $15.49
| Facility | | $14.13 | $14.13 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $18.62 / $26.92
| Professional | | $16.98 | $18.62 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $14.79 / $26.30
| Professional | | $11.22 | $14.79 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $32.36 / $33.11
| Professional | | $25.12 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $18.20 / $109.65
| Facility | | $7.59 | $18.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $13.49 / $19.50
| Professional | | $10.47 | $13.49 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $95.50
| Professional | 25 | $95.50 | $95.50 | $95.50 |