- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $257.04 / $812.83
| Facility | | $64.57 | $257.04 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $28.84 / $85.11
| Professional | | $12.88 | $28.84 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $120.23 / $120.23 / $120.23
| Professional | 25 | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.79 / $20.42
| Professional | | $11.48 | $14.79 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $147.91 / $295.12
| Facility | | $58.88 | $147.91 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $11.75 / $22.91
| Professional | | $10.23 | $11.75 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $74.13 / $147.91
| Facility | | $13.80 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.95 / $27.54
| Professional | | $13.49 | $19.95 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $63.10 / $114.82
| Facility | | $23.99 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.50 / $35.48
| Professional | | $13.80 | $19.50 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.50 / $28.84
| Professional | | $14.13 | $19.50 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $213.80 / $645.65
| Facility | | $20.42 | $213.80 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $21.88 / $75.86
| Professional | | $11.75 | $21.88 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $32.36 / $33.11
| Professional | | $11.22 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $19.05 / $72.44
| Facility | | $14.45 | $19.05 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $35.48
| Professional | | $13.80 | $19.05 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $114.82 / $151.36
| Facility | | $25.70 | $114.82 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.99 / $36.31
| Professional | | $12.59 | $23.99 | $36.31 |