- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.90
| Facility | | $30.20 | $30.20 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.11 / $97.72
| Professional | | $25.12 | $33.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.70 / $53.70 / $144.54
| Professional | 25 | $25.70 | $53.70 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $56.23 / $134.90
| Facility | | $19.50 | $56.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $77.62 / $114.82
| Professional | | $46.77 | $77.62 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $54.95 / $61.66 / $61.66
| Professional | 25 | $54.95 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $104.71 / $288.40
| Facility | | $69.18 | $104.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $36.31 / $44.67
| Professional | | $33.88 | $36.31 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $112.20 / $223.87
| Facility | | $74.13 | $112.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $35.48 / $35.48
| Professional | | $33.88 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $40.74 / $85.11
| Facility | | $28.84 | $40.74 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $194.98
| Professional | | $33.11 | $63.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $56.23 / $97.72
| Professional | | $31.62 | $56.23 | $97.72 |