- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $74.13
| Facility | | $72.44 | $72.44 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $114.82
| Professional | | $24.55 | $34.67 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $50.12
| Professional | 25 | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $67.61
| Professional | | $31.62 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $53.70 / $97.72
| Professional | | $25.12 | $53.70 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $61.66
| Facility | | $28.18 | $36.31 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $51.29 / $204.17
| Professional | | $32.36 | $51.29 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $77.62
| Professional | | $44.67 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $75.86 / $87.10
| Professional | | $57.54 | $75.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $36.31 / $64.57
| Professional | | $28.18 | $36.31 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $34.67 / $41.69
| Facility | | $33.11 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $75.86
| Professional | | $30.90 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $45.71
| Professional | | $34.67 | $43.65 | $45.71 |