- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $83.18 / $154.88
| Facility | | $23.99 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $75.86
| Professional | | $24.55 | $37.15 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $36.31 / $57.54 / $128.82
| Professional | 25 | $36.31 | $57.54 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $56.23
| Professional | | $32.36 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 25 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $38.02 / $70.79
| Professional | | $26.30 | $38.02 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $47.86
| Facility | | $27.54 | $36.31 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $45.71 / $57.54
| Professional | | $34.67 | $45.71 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $50.12
| Professional | | $37.15 | $37.15 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $40.74 / $67.61
| Professional | | $25.12 | $40.74 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $26.30
| Professional | 52 | $16.22 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $50.12 / $87.10
| Professional | | $26.92 | $50.12 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $154.88
| Facility | | $35.48 | $41.69 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $39.81 / $70.79
| Professional | | $26.92 | $39.81 | $70.79 |