- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $56.23 / $100.00
| Facility | | $22.91 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $38.90
| Professional | | $18.20 | $21.88 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.84 / $50.12
| Facility | | $25.12 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.80 / $31.62
| Professional | | $10.96 | $13.80 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $30.90
| Facility | | $16.22 | $16.22 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $138.04
| Facility | | $18.20 | $32.36 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.88 / $52.48
| Professional | | $12.30 | $12.88 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $18.20 / $223.87
| Facility | | $17.78 | $18.20 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $12.88 / $23.44
| Professional | | $12.30 | $12.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $33.88
| Professional | | $20.42 | $25.70 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Facility | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $54.95
| Professional | | $19.05 | $28.18 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $26.92 / $40.74
| Facility | | $12.02 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $16.22 / $26.92
| Professional | | $11.48 | $16.22 | $26.92 |