- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $33.11 / $51.29
| Facility | | $5.25 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.27 / $9.55 / $42.66
| Professional | | $4.27 | $9.55 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $4.90 / $9.77 / $34.67
| Professional | 25 | $4.90 | $9.77 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.68 / $6.92
| Professional | | $3.55 | $4.68 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $21.38
| Facility | | $6.92 | $6.92 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.92
| Professional | | $6.03 | $6.03 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $4.17 / $5.62
| Facility | | $3.02 | $4.17 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.07 / $5.01 / $9.77
| Professional | | $4.07 | $5.01 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $7.59
| Professional | | $3.02 | $3.98 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $20.89 / $41.69
| Facility | | $5.01 | $20.89 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $6.61 / $30.20
| Professional | | $3.98 | $6.61 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $4.90 / $5.50 / $30.20
| Professional | 25 | $4.90 | $5.50 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.98 / $6.03
| Professional | | $3.02 | $3.98 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $104.71
| Facility | | $38.02 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $5.89 / $8.91
| Professional | | $4.57 | $5.89 | $8.91 |