- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $302.00 / $602.56
| Facility | | $38.90 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $48.98
| Professional | | $19.05 | $25.12 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $234.42 / $281.84
| Facility | | $181.97 | $234.42 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $28.84
| Professional | | $17.38 | $17.38 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $79.43 / $177.83
| Facility | | $35.48 | $79.43 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $54.95
| Professional | | $19.95 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $52.48 / $54.95
| Professional | | $36.31 | $52.48 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $30.20
| Facility | | $25.70 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $30.20
| Professional | | $14.45 | $14.45 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $10,000.00
| Facility | | $32.36 | $56.23 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $10,000.00
| Professional | | $32.36 | $56.23 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $40.74 / $48.98
| Facility | | $19.50 | $40.74 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $43.65
| Professional | | $18.62 | $23.99 | $43.65 |