- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $34.67 / $141.25
| Facility | | $10.00 | $34.67 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $20.89 / $53.70
| Professional | | $10.00 | $20.89 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | 50 | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $20.42
| Professional | | $16.98 | $16.98 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $239.88
| Facility | | $64.57 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $22.39 / $38.90
| Professional | | $12.88 | $22.39 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $23.99 / $47.86
| Professional | | $12.59 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $34.67 / $102.33
| Professional | | $16.60 | $34.67 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $14.13 / $26.30
| Professional | | $13.18 | $14.13 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $645.65 / $2,089.30
| Facility | | $50.12 | $645.65 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $27.54 / $53.70
| Professional | | $12.59 | $27.54 | $53.70 |