- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $95.50 / $239.88
| Facility | | $15.14 | $95.50 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $56.23 / $95.50 / $181.97
| Facility | 25 | $56.23 | $95.50 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $20.42 / $61.66
| Professional | | $7.08 | $20.42 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $21.38 / $38.90 / $79.43
| Professional | 25 | $21.38 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $23.99 / $48.98
| Professional | | $10.72 | $23.99 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $10.72 / $15.49
| Facility | | $8.13 | $10.72 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $48.98
| Professional | | $21.38 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $117.49
| Facility | | $56.23 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $25.12 / $60.26
| Professional | | $10.72 | $25.12 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $18.20 / $33.11
| Facility | | $7.59 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $30.90 / $60.26
| Professional | | $14.79 | $30.90 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $19.05 / $42.66
| Facility | | $7.59 | $19.05 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | 25 | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $47.86 / $489.78
| Professional | | $21.88 | $47.86 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.12 / $66.07 / $97.72
| Professional | 25 | $25.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $29.51 / $58.88
| Professional | | $12.02 | $29.51 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $26.92 / $67.61
| Professional | | $12.02 | $26.92 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $489.78
| Facility | | $22.39 | $27.54 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $28.84 / $489.78
| Professional | | $10.47 | $28.84 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $27.54
| Professional | | $10.47 | $10.47 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $48.98
| Professional | | $12.59 | $27.54 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $48.98
| Facility | | $25.70 | $33.11 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $54.95 / $79.43
| Professional | | $19.05 | $54.95 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $79.43
| Professional | 25 | $24.55 | $28.84 | $79.43 |