- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $36.31 / $46.77
| Facility | | $34.67 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $41.69
| Professional | | $19.95 | $25.12 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $26.92 / $95.50 / $97.72
| Professional | 25 | $26.92 | $95.50 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $25.70 / $30.20
| Professional | | $21.88 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.99 / $28.18 / $33.11
| Professional | 25 | $23.99 | $28.18 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $112.20 / $181.97
| Facility | | $66.07 | $112.20 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $25.70 / $34.67
| Professional | | $23.44 | $25.70 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $47.86
| Professional | | $23.99 | $33.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $38.90
| Professional | | $26.92 | $32.36 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $51.29
| Facility | | $21.88 | $31.62 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $66.07
| Professional | | $24.55 | $38.02 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $162.18
| Facility | | $28.18 | $34.67 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $36.31 / $52.48
| Professional | | $25.12 | $36.31 | $52.48 |