- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $57.54 / $63.10
| Facility | | $12.02 | $57.54 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $19.50 / $34.67
| Professional | | $10.00 | $19.50 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $22.91 / $31.62 / $41.69
| Professional | 25 | $22.91 | $31.62 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $11.75 / $18.20
| Facility | | $10.00 | $11.75 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $23.44
| Professional | | $11.75 | $15.14 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $21.38 / $32.36
| Professional | | $10.72 | $21.38 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $16.98 / $26.92
| Facility | | $10.72 | $16.98 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $21.38 / $199.53
| Professional | | $12.30 | $21.38 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $29.51
| Professional | | $15.85 | $23.99 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $19.50 / $32.36
| Professional | | $16.22 | $19.50 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $20.42 / $27.54
| Professional | | $14.45 | $20.42 | $27.54 |
- 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
- $11.48 / $18.20 / $31.62
| Professional | | $11.48 | $18.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $95.50
| Professional | 25 | $79.43 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $20.89 / $25.70
| Professional | | $19.95 | $20.89 | $25.70 |