- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $21.88 / $112.20
| Facility | | $7.59 | $21.88 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $512.86
| Facility | 25 | $61.66 | $102.33 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $20.89 / $54.95
| Professional | | $7.08 | $20.89 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.78 / $33.88 / $79.43
| Professional | 25 | $17.78 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $21.38 / $32.36
| Professional | | $7.59 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $41.69
| Professional | 25 | $18.20 | $22.91 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $25.12 / $27.54
| Facility | | $23.44 | $25.12 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $39.81
| Professional | | $21.38 | $24.55 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.96 / $14.79
| Facility | | $8.32 | $10.96 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $48.98
| Professional | | $21.38 | $27.54 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $147.91
| Facility | | $134.90 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $20.42 / $37.15
| Professional | | $8.32 | $20.42 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $20.42 / $123.03
| Facility | | $7.59 | $20.42 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $61.66 / $102.33 / $707.95
| Facility | 25 | $61.66 | $102.33 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $19.05 / $41.69
| Professional | | $7.08 | $19.05 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $17.78 / $34.67 / $79.43
| Professional | 25 | $17.78 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $147.91
| Facility | | $134.90 | $134.90 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $20.42 / $28.84
| Professional | | $8.32 | $20.42 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $18.20 / $28.18
| Facility | | $16.22 | $18.20 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $20.89 / $48.98
| Professional | | $8.91 | $20.89 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | 25 | $24.55 | $24.55 | $24.55 |