- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $52.48 / $57.54
| Facility | | $33.11 | $52.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $69.18
| Professional | | $20.42 | $26.92 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $26.92 / $95.50 / $104.71
| Professional | 25 | $26.92 | $95.50 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $39.81 / $66.07
| Professional | | $22.39 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $38.90 / $83.18
| Professional | | $23.44 | $38.90 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $53.70
| Facility | | $21.88 | $30.90 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $346.74
| Professional | | $25.70 | $37.15 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $50.12 / $67.61
| Professional | | $33.88 | $50.12 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $53.70 / $75.86
| Professional | | $30.20 | $53.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $40.74 / $61.66
| Professional | | $23.44 | $40.74 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $33.11 / $77.62
| Facility | | $21.88 | $33.11 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $64.57
| Professional | | $24.55 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $42.66 / $46.77
| Professional | | $33.88 | $42.66 | $46.77 |