- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $43.65
| Facility | | $33.88 | $38.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $87.10
| Professional | | $19.95 | $28.18 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $27.54 / $40.74 / $57.54
| Professional | 25 | $27.54 | $40.74 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $26.30
| Professional | | $20.42 | $20.42 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $30.20 / $42.66
| Professional | | $23.99 | $30.20 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $42.66
| Professional | | $22.39 | $30.90 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Facility | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $37.15 / $63.10
| Professional | | $27.54 | $37.15 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $50.12
| Facility | | $19.95 | $26.92 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.02 / $181.97
| Professional | | $26.92 | $38.02 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- 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
- $22.39 / $30.90 / $46.77
| Professional | | $22.39 | $30.90 | $46.77 |