- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $177.83 / $549.54
| Facility | | $40.74 | $177.83 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $19.95 / $44.67
| Professional | | $18.20 | $19.95 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $109.65
| Facility | | $26.30 | $26.30 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $17.38
| Professional | | $10.47 | $10.47 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $134.90
| Professional | | $57.54 | $91.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $50.12 / $117.49
| Facility | | $26.30 | $50.12 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $15.85 / $33.11
| Professional | | $12.88 | $15.85 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $38.90
| Professional | | $26.30 | $31.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $32.36 / $38.02
| Professional | | $4.37 | $32.36 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $19.05 / $22.39
| Facility | | $16.60 | $19.05 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $32.36 / $54.95
| Professional | | $16.60 | $32.36 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $10,000.00
| Facility | | $20.89 | $34.67 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $35.48 / $10,000.00
| Professional | | $20.89 | $35.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $26.30 / $33.11
| Facility | | $10.96 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.59 / $26.30
| Professional | | $10.96 | $12.59 | $26.30 |