- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $371.54 / $776.25
| Facility | | $102.33 | $371.54 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $245.47 / $371.54 / $1,096.48
| Facility | 25 | $245.47 | $371.54 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $20.42 / $66.07
| Professional | | $7.08 | $20.42 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $21.88 / $36.31 / $61.66
| Professional | 25 | $21.88 | $36.31 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $575.44 / $575.44
| Facility | | $467.74 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $29.51 / $67.61
| Professional | | $14.13 | $29.51 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $22.39
| Facility | | $11.22 | $13.80 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $46.77 / $56.23
| Facility | | $44.67 | $46.77 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $31.62 / $45.71
| Professional | | $15.85 | $31.62 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $22.39 / $63.10
| Facility | | $10.23 | $22.39 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $21.88 / $63.10
| Facility | | $10.23 | $21.88 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $57.54
| Professional | | $16.98 | $26.30 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Facility | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Professional | | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $41.69 / $102.33
| Professional | | $21.38 | $41.69 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | 25 | $85.11 | $85.11 | $85.11 |