- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $16.60 / $23.99
| Facility | | $13.18 | $16.60 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Facility | 25 | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $17.38 / $33.88
| Professional | | $10.72 | $17.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.60 / $24.55 / $53.70
| Professional | 25 | $16.60 | $24.55 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $17.38
| Professional | | $11.22 | $13.80 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.47 / $13.80 / $15.85
| Professional | 25 | $10.47 | $13.80 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.88 / $20.42
| Professional | | $10.23 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $19.50
| Professional | | $10.72 | $14.79 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Facility | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.85 / $26.30
| Professional | | $11.22 | $15.85 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $14.45 / $26.30
| Facility | | $9.77 | $14.45 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.60 / $199.53
| Professional | | $12.30 | $16.60 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $17.78
| Professional | 25 | $14.45 | $14.45 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $14.45 / $19.05
| Professional | | $11.48 | $14.45 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.22 / $17.38 / $20.42
| Professional | 25 | $16.22 | $17.38 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $239.88
| Facility | | $12.30 | $18.20 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.45 / $22.91
| Professional | | $10.72 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $95.50
| Professional | 25 | $16.98 | $30.20 | $95.50 |