- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $50.12 / $134.90
| Facility | | $15.85 | $50.12 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $18.20 / $22.91
| Professional | | $15.85 | $18.20 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $95.50
| Facility | | $22.91 | $22.91 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $17.38
| Professional | | $11.22 | $11.22 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $107.15 / $158.49
| Professional | | $67.61 | $107.15 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $58.88 / $102.33
| Facility | | $22.91 | $58.88 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $16.60 / $32.36
| Professional | | $12.30 | $16.60 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $33.88
| Professional | | $22.91 | $26.92 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $38.02 / $44.67
| Professional | | $18.62 | $38.02 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $21.38
| Facility | | $19.50 | $20.42 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $47.86
| Professional | | $19.50 | $38.90 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $33.11 / $10,000.00
| Facility | | $17.78 | $33.11 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $10,000.00
| Professional | | $17.78 | $32.36 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $22.91 / $38.90
| Facility | | $9.55 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $13.49 / $23.99
| Professional | | $9.55 | $13.49 | $23.99 |