- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $41.69
| Facility | | $23.44 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $15.14 / $44.67
| Professional | | $10.00 | $15.14 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | 25 | $44.67 | $44.67 | $44.67 |
- 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
- $14.79 / $26.92 / $40.74
| Professional | | $14.79 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $27.54 / $38.02
| Professional | | $20.42 | $27.54 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.60 / $28.18
| Facility | | $10.96 | $16.60 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $26.30 / $39.81
| Professional | | $13.80 | $26.30 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Professional | 25 | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $29.51 / $29.51
| Facility | | $18.20 | $29.51 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.22 / $28.84
| Facility | | $10.96 | $16.22 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $41.69
| Professional | | $22.91 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $28.84 / $39.81
| Professional | | $20.89 | $28.84 | $39.81 |
- 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
- $14.45 / $25.12 / $37.15
| Professional | | $14.45 | $25.12 | $37.15 |