- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $50.12 / $97.72
| Facility | | $10.96 | $50.12 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 25
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Facility | 25 | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $41.69 / $114.82
| Professional | | $16.98 | $41.69 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $63.10 / $128.82 / $131.83
| Professional | 25 | $63.10 | $128.82 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $147.91
| Facility | | $25.12 | $33.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $42.66 / $117.49
| Professional | | $19.50 | $42.66 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $29.51 / $41.69
| Facility | | $20.89 | $29.51 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $43.65
| Professional | | $42.66 | $42.66 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $20.42 / $32.36
| Facility | | $14.79 | $20.42 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $63.10 / $91.20
| Professional | | $44.67 | $63.10 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $40.74 / $56.23
| Professional | | $19.05 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $43.65 / $66.07
| Professional | | $17.78 | $43.65 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $147.91
| Facility | | $25.12 | $33.88 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $42.66 / $117.49
| Professional | | $19.50 | $42.66 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $51.29
| Facility | | $23.99 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $91.20
| Professional | | $35.48 | $48.98 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $34.67 / $42.66
| Facility | | $10.00 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $32.36 / $74.13
| Professional | | $18.62 | $32.36 | $74.13 |