- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $30.90 / $36.31
| Facility | | $7.08 | $30.90 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $9.33 / $26.92
| Professional | | $7.08 | $9.33 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Professional | 25 | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $37.15
| Professional | | $15.14 | $20.42 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | 25 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.49 / $16.98
| Facility | | $14.13 | $15.49 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $19.50 / $24.55
| Professional | | $10.96 | $19.50 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $32.36 / $32.36
| Facility | | $28.84 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $13.80 / $30.90
| Professional | | $9.12 | $13.80 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $10.00 / $25.70
| Professional | | $4.47 | $10.00 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $24.55 / $33.11
| Professional | | $10.47 | $24.55 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $7.41 / $25.70
| Facility | | $5.62 | $7.41 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.23 / $21.38
| Professional | | $7.08 | $10.23 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $23.44
| Professional | | $9.12 | $9.12 | $23.44 |