- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $35.48
| Facility | | $24.55 | $28.84 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $51.29
| Professional | | $19.95 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $95.50 / $112.20
| Professional | 25 | $28.84 | $95.50 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $33.88
| Professional | | $21.88 | $27.54 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $29.51
| Professional | 25 | $21.88 | $27.54 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $38.90
| Facility | | $28.18 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $36.31
| Professional | | $22.39 | $27.54 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $43.65
| Facility | | $23.44 | $32.36 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $61.66
| Professional | | $25.70 | $34.67 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $38.02
| Facility | | $25.70 | $25.70 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $50.12
| Professional | | $22.39 | $30.90 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $41.69
| Professional | | $30.90 | $36.31 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $30.90 / $36.31 / $40.74
| Professional | 25 | $30.90 | $36.31 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $48.98
| Facility | | $34.67 | $45.71 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $39.81
| Professional | | $22.91 | $28.18 | $39.81 |