- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $19.05 / $257.04
| Facility | | $10.47 | $19.05 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $18.62 / $38.90
| Professional | | $10.00 | $18.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $19.50
| Professional | | $16.98 | $16.98 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $10,715.19 / $11,220.18
| Facility | | $3,801.89 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $21.38 / $38.90
| Professional | | $12.88 | $21.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $19.50 / $32.36 / $57.54
| Professional | 50 | $19.50 | $32.36 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $19.50
| Facility | | $10.47 | $14.13 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $14.13 / $16.98
| Professional | | $10.47 | $14.13 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $34.67
| Facility | | $19.05 | $19.05 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $35.48 / $208.93
| Professional | | $14.45 | $35.48 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $33.11
| Professional | | $16.60 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $724.44 / $1,949.84
| Facility | | $44.67 | $724.44 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $26.30 / $50.12
| Professional | | $12.30 | $26.30 | $50.12 |