- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $52.48 / $109.65
| Facility | | $19.95 | $52.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.05 / $25.70
| Professional | | $15.85 | $19.05 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $93.33
| Facility | | $21.88 | $21.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $10.96 / $16.22
| Professional | | $10.96 | $10.96 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $102.33 / $154.88
| Professional | | $64.57 | $102.33 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $53.70 / $100.00
| Facility | | $22.39 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $16.22 / $38.02
| Professional | | $12.02 | $16.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.30 / $32.36
| Professional | | $21.88 | $26.30 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $37.15 / $42.66
| Professional | | $7.08 | $37.15 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.95 / $20.89
| Facility | | $19.05 | $19.95 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $45.71 / $47.86
| Professional | | $19.05 | $45.71 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $10,000.00
| Facility | | $16.98 | $26.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $26.30 / $10,000.00
| Professional | | $16.98 | $26.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $21.88 / $38.02
| Facility | | $9.12 | $21.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $12.88 / $22.91
| Professional | | $9.12 | $12.88 | $22.91 |