- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $26.92
| Professional | | $7.08 | $10.00 | $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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $38.02 / $47.86
| Facility | | $21.38 | $38.02 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $51.29 / $64.57
| Professional | | $29.51 | $51.29 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $51.29
| Professional | 25 | $23.44 | $40.74 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $69.18 / $190.55
| Facility | | $45.71 | $69.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $48.98 / $83.18
| Professional | | $14.79 | $48.98 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $75.86 / $147.91
| Facility | | $50.12 | $75.86 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $50.12 / $75.86
| Professional | | $31.62 | $50.12 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $25.12 / $56.23
| Facility | | $8.91 | $25.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $16.98 / $107.15
| Professional | | $8.91 | $16.98 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Facility | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $20.89 / $56.23
| Professional | | $9.33 | $20.89 | $56.23 |