- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $57.54 / $120.23
| Facility | | $22.91 | $57.54 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.38 / $26.30
| Professional | | $16.98 | $21.38 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $23.99 / $102.33
| Facility | | $23.99 | $23.99 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $18.62
| Professional | | $12.02 | $12.02 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $114.82 / $169.82
| Professional | | $72.44 | $114.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $61.66 / $109.65
| Facility | | $24.55 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.78 / $35.48
| Professional | | $13.18 | $17.78 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $28.84 / $35.48
| Professional | | $23.99 | $28.84 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $46.77
| Professional | | $19.95 | $40.74 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $21.88 / $23.44
| Facility | | $20.89 | $21.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $31.62 / $51.29
| Professional | | $20.89 | $31.62 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $38.02 / $10,000.00
| Facility | | $19.95 | $38.02 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $38.02 / $10,000.00
| Professional | | $19.95 | $38.02 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $23.99 / $41.69
| Facility | | $12.02 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $14.45 / $26.30
| Professional | | $10.23 | $14.45 | $26.30 |