- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $24.55 / $177.83
| Facility | | $7.59 | $24.55 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $74.13 / $154.88 / $257.04
| Facility | 25 | $74.13 | $154.88 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $19.95 / $46.77
| Professional | | $7.59 | $19.95 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $33.11 / $75.86
| Professional | 25 | $19.05 | $33.11 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $22.39 / $33.88
| Professional | | $8.32 | $22.39 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $18.20 / $22.39 / $32.36
| Professional | 25 | $18.20 | $22.39 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $16.22 / $17.78
| Facility | | $15.14 | $16.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $19.50 / $25.70
| Professional | | $7.94 | $19.50 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $125.89 / $190.55
| Facility | | $27.54 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $20.89 / $38.02
| Professional | | $9.12 | $20.89 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $223.87 / $416.87
| Facility | | $162.18 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $20.42 / $144.54
| Professional | | $10.23 | $20.42 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $26.30 / $37.15
| Professional | | $7.24 | $26.30 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $16.98 / $48.98
| Facility | | $9.12 | $16.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $17.78 / $36.31
| Professional | | $7.59 | $17.78 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $13.49 / $28.84 / $79.43
| Professional | 25 | $13.49 | $28.84 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.61 / $17.78 / $23.44
| Professional | | $6.61 | $17.78 | $23.44 |