- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $44.67 / $199.53
| Facility | | $15.85 | $44.67 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $22.39
| Professional | | $12.02 | $14.79 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $70.79
| Facility | | $16.60 | $16.60 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $8.32 / $12.88
| Professional | | $8.32 | $8.32 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $79.43 / $117.49
| Professional | | $48.98 | $79.43 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $43.65 / $75.86
| Facility | | $16.98 | $43.65 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.30 / $28.84
| Professional | | $9.12 | $12.30 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.95 / $24.55
| Professional | | $16.60 | $19.95 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $28.18 / $32.36
| Professional | | $13.80 | $28.18 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $15.14 / $15.85
| Facility | | $14.45 | $15.14 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $33.88 / $35.48
| Professional | | $14.45 | $33.88 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $10,000.00
| Facility | | $12.88 | $23.99 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $23.99 / $10,000.00
| Professional | | $12.88 | $23.99 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $16.60 / $28.84
| Facility | | $7.08 | $16.60 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.00 / $17.38
| Professional | | $7.08 | $10.00 | $17.38 |