- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $114.82 / $346.74
| Facility | | $35.48 | $114.82 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $56.23
| Professional | | $19.95 | $25.12 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $120.23
| Facility | | $28.18 | $28.18 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $21.38
| Professional | | $13.80 | $13.80 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $131.83 / $194.98
| Professional | | $83.18 | $131.83 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $72.44 / $125.89
| Facility | | $28.18 | $72.44 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $20.42 / $39.81
| Professional | | $15.14 | $20.42 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $41.69
| Professional | | $28.18 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $54.95
| Professional | | $22.91 | $46.77 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $25.12 / $28.18
| Facility | | $23.99 | $25.12 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $23.99 / $58.88
| Professional | | $18.62 | $23.99 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $46.77 / $10,000.00
| Facility | | $24.55 | $46.77 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $47.86 / $10,000.00
| Professional | | $24.55 | $47.86 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $28.18 / $47.86
| Facility | | $14.13 | $28.18 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $16.60 / $30.90
| Professional | | $11.75 | $16.60 | $30.90 |