- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $66.07 / $363.08
| Facility | | $19.95 | $66.07 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $77.62 / $154.88 / $691.83
| Facility | 25 | $77.62 | $154.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.24 / $22.39 / $58.88
| Professional | | $7.24 | $22.39 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $79.43
| Professional | 25 | $19.05 | $36.31 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $30.20
| Facility | | $27.54 | $27.54 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $23.44 / $52.48
| Professional | | $10.47 | $23.44 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $23.99 / $58.88
| Professional | | $14.45 | $23.99 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $22.39 / $46.77
| Facility | | $8.51 | $22.39 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $81.28 / $169.82 / $691.83
| Facility | 25 | $81.28 | $169.82 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $25.70 / $54.95
| Professional | | $11.48 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $36.31 / $77.62
| Professional | 25 | $19.05 | $36.31 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $45.71
| Facility | | $21.88 | $39.81 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $21.38 / $41.69
| Facility | | $8.13 | $21.38 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.88 / $70.79
| Professional | | $16.22 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $18.62
| Facility | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $60.26
| Professional | | $15.14 | $26.92 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $48.98
| Facility | | $28.18 | $28.18 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $25.70 / $54.95
| Professional | | $12.59 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $28.84 / $79.43 / $79.43
| Professional | 25 | $28.84 | $79.43 | $79.43 |