- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $66.07 / $173.78
| Facility | | $13.18 | $66.07 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $93.33 / $151.36
| Facility | 25 | $63.10 | $93.33 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $19.05 / $43.65
| Professional | | $6.03 | $19.05 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $18.20 / $38.02 / $48.98
| Professional | 25 | $18.20 | $38.02 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $23.44 / $47.86
| Professional | | $13.49 | $23.44 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $43.65
| Professional | 25 | $20.89 | $25.12 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $81.28 / $165.96
| Facility | | $58.88 | $81.28 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $19.05 / $43.65
| Professional | | $8.71 | $19.05 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $147.91
| Facility | | $26.92 | $30.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $21.88 / $53.70
| Professional | | $9.12 | $21.88 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $20.42 / $41.69
| Facility | | $7.94 | $20.42 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $95.50 / $95.50 / $109.65
| Facility | 25 | $95.50 | $95.50 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $39.81 / $489.78
| Professional | | $20.89 | $39.81 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $53.70
| Professional | 25 | $38.02 | $44.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $33.88 / $44.67
| Professional | | $16.60 | $33.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $52.48
| Professional | | $15.85 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $46.77
| Professional | | $19.95 | $35.48 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $44.67 / $177.83
| Facility | | $28.18 | $44.67 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $25.12 / $54.95
| Professional | | $10.72 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Professional | 25 | $28.84 | $28.84 | $28.84 |