- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $79.43 / $125.89
| Facility | | $30.90 | $79.43 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $52.48
| Professional | | $19.05 | $22.91 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $177.83 / $5,011.87
| Facility | | $131.83 | $177.83 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $24.55
| Professional | | $22.91 | $22.91 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $42.66 / $100.00
| Facility | | $20.89 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.11 / $60.26
| Professional | | $14.45 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $18.62 / $41.69
| Professional | | $13.80 | $18.62 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $50.12
| Professional | | $24.55 | $28.84 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $60.26
| Facility | | $33.88 | $33.88 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $66.07 / $100.00
| Facility | | $23.99 | $66.07 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $33.88
| Professional | | $19.05 | $22.91 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $53.70
| Facility | | $16.22 | $28.84 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $29.51 / $53.70
| Professional | | $16.22 | $29.51 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $28.84 / $34.67
| Facility | | $14.79 | $28.84 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.62 / $43.65
| Professional | | $12.30 | $18.62 | $43.65 |