- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.88 / $12.88
| Facility | | $10.96 | $12.88 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $14.45 / $36.31
| Professional | | $10.00 | $14.45 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $22.39
| Professional | 25 | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $95.50
| Facility | | $23.44 | $23.44 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $33.11 / $44.67
| Professional | | $19.50 | $33.11 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $15.49 / $26.92 / $36.31
| Professional | 25 | $15.49 | $26.92 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $47.86 / $131.83
| Facility | | $32.36 | $47.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $54.95
| Professional | | $19.05 | $33.11 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $53.70 / $104.71
| Facility | | $34.67 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $50.12
| Professional | | $21.38 | $31.62 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $17.38 / $37.15
| Facility | | $10.96 | $17.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $36.31 / $81.28
| Professional | | $15.49 | $36.31 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $48.98
| Professional | 25 | $47.86 | $47.86 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $24.55 / $41.69
| Professional | | $13.49 | $24.55 | $41.69 |