- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $40.74 / $52.48
| Facility | | $5.62 | $40.74 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $57.54
| Professional | | $19.95 | $27.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.12 / $50.12 / $87.10
| Professional | 25 | $25.12 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $35.48
| Professional | | $21.88 | $25.70 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $45.71
| Professional | 25 | $20.42 | $28.18 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $67.61 / $85.11
| Facility | | $47.86 | $67.61 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $37.15
| Professional | | $27.54 | $30.90 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $46.77
| Facility | | $33.11 | $33.11 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $53.70
| Professional | | $22.91 | $33.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $44.67 / $89.13
| Professional | | $26.30 | $44.67 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $30.90 / $36.31
| Professional | | $29.51 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $43.65
| Professional | | $32.36 | $33.11 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $100.00 / $128.82
| Facility | | $23.99 | $100.00 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $54.95
| Professional | | $23.99 | $33.88 | $54.95 |