- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.50 / $43.65
| Facility | | $14.13 | $19.50 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.05 / $21.38 / $44.67
| Facility | 25 | $19.05 | $21.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $16.98 / $36.31
| Professional | | $10.96 | $16.98 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $48.98
| Professional | 25 | $15.14 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $23.99
| Professional | | $10.72 | $14.79 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $10.72 / $14.79 / $25.70
| Professional | 25 | $10.72 | $14.79 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $18.20 / $32.36
| Professional | | $11.75 | $18.20 | $32.36 |
- 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
- $11.75 / $16.60 / $30.20
| Professional | | $11.75 | $16.60 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $15.14 / $28.18
| Professional | | $11.75 | $15.14 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $25.12
| Facility | | $11.22 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $38.02
| Professional | | $9.77 | $9.77 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $26.92
| Professional | | $15.14 | $22.91 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $18.20
| Facility | | $15.85 | $15.85 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $23.99
| Professional | | $10.47 | $14.13 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $16.98 / $30.20 / $95.50
| Professional | 25 | $16.98 | $30.20 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |