- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $14.13
| Facility | | $7.08 | $7.08 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $15.14 / $32.36
| Professional | | $7.08 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Professional | 25 | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $15.49 / $19.95
| Professional | | $6.61 | $15.49 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $12.30 / $60.26
| Facility | | $8.91 | $12.30 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $14.79 / $26.30
| Professional | | $8.32 | $14.79 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $14.13
| Facility | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $14.79 / $25.12
| Facility | | $8.13 | $14.79 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.44 / $117.49
| Professional | | $15.85 | $23.44 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $12.02 / $15.85
| Facility | | $6.92 | $12.02 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $16.22 / $27.54
| Professional | | $8.71 | $16.22 | $27.54 |