- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $87.10 / $169.82
| Facility | | $20.89 | $87.10 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.79 / $19.95
| Professional | | $12.02 | $14.79 | $19.95 |
- 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
- $8.13 / $8.13 / $12.59
| Professional | | $8.13 | $8.13 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $77.62 / $114.82
| Professional | | $48.98 | $77.62 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $41.69 / $74.13
| Facility | | $16.60 | $41.69 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.30 / $26.92
| Professional | | $9.12 | $12.30 | $26.92 |
- 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 / $27.54 / $32.36
| Professional | | $13.80 | $27.54 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.79 / $15.49
| Facility | | $14.13 | $14.79 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $34.67
| Professional | | $14.13 | $19.95 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $27.54 / $10,000.00
| Facility | | $14.79 | $27.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $28.18 / $10,000.00
| Professional | | $14.79 | $28.18 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $16.60 / $28.18
| Facility | | $6.92 | $16.60 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $9.77 / $17.38
| Professional | | $6.92 | $9.77 | $17.38 |