- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $109.65 / $302.00
| Facility | | $37.15 | $109.65 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $39.81 / $52.48
| Professional | | $37.15 | $39.81 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $50.12 / $213.80
| Facility | | $50.12 | $50.12 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $38.90
| Professional | | $25.12 | $25.12 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $239.88 / $354.81
| Professional | | $147.91 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $131.83 / $229.09
| Facility | | $51.29 | $131.83 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $35.48 / $72.44
| Professional | | $27.54 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $60.26 / $74.13
| Professional | | $50.12 | $60.26 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $85.11 / $97.72
| Professional | | $41.69 | $85.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $54.95 / $54.95
| Facility | | $42.66 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $104.71
| Professional | | $42.66 | $43.65 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $10,000.00
| Facility | | $38.90 | $79.43 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $10,000.00
| Professional | | $38.90 | $79.43 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $50.12 / $87.10
| Facility | | $21.38 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $30.20 / $52.48
| Professional | | $21.38 | $30.20 | $52.48 |