- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $91.20 / $288.40
| Facility | | $20.89 | $91.20 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.02 / $52.48
| Professional | | $34.67 | $38.02 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $204.17
| Facility | | $47.86 | $47.86 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $35.48
| Professional | | $23.44 | $23.44 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $295.12 / $446.68
| Professional | | $186.21 | $295.12 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $114.82 / $218.78
| Facility | | $48.98 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $31.62 / $58.88
| Professional | | $23.99 | $31.62 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $57.54 / $70.79
| Professional | | $47.86 | $57.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $44.67
| Facility | | $34.67 | $34.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.90 / $100.00
| Professional | | $23.99 | $38.90 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $74.13 / $10,000.00
| Facility | | $37.15 | $74.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $74.13 / $10,000.00
| Professional | | $37.15 | $74.13 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $47.86 / $72.44
| Facility | | $19.95 | $47.86 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.84 / $58.88
| Professional | | $19.95 | $28.84 | $58.88 |