- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $19.05 / $31.62
| Facility | | $9.12 | $19.05 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $91.20 / $295.12 / $512.86
| Facility | 25 | $91.20 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $20.42 / $44.67
| Professional | | $7.08 | $20.42 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $30.90 / $61.66
| Professional | 25 | $19.05 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $21.88 / $30.20
| Professional | | $8.51 | $21.88 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $9.12 / $22.39 / $27.54
| Professional | 25 | $9.12 | $22.39 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $14.45 / $83.18
| Facility | | $12.88 | $14.45 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $16.60 / $22.91
| Professional | | $8.13 | $16.60 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $20.42 / $21.88
| Facility | | $7.59 | $20.42 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $141.25 / $169.82
| Facility | | $33.88 | $141.25 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $19.50 / $36.31
| Professional | | $8.32 | $19.50 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.18
| Facility | | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $18.20 / $30.20
| Professional | | $7.76 | $18.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $79.43
| Professional | 25 | $24.55 | $28.84 | $79.43 |