- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $42.66 / $112.20
| Facility | | $14.13 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.14 / $19.05
| Professional | | $14.13 | $15.14 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $81.28
| Facility | | $19.50 | $19.50 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $14.79
| Professional | | $9.33 | $9.33 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $89.13 / $131.83
| Professional | | $56.23 | $89.13 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $44.67 / $87.10
| Facility | | $12.59 | $44.67 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $12.59 / $19.50
| Professional | | $9.55 | $12.59 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $28.84
| Professional | | $19.50 | $23.44 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $31.62 / $37.15
| Professional | | $3.89 | $31.62 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $20.89 / $20.89
| Facility | | $16.22 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $16.22 / $40.74
| Professional | | $5.50 | $16.22 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $26.92 / $10,000.00
| Facility | | $14.13 | $26.92 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $26.92 / $10,000.00
| Professional | | $14.13 | $26.92 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $19.50 / $32.36
| Facility | | $8.13 | $19.50 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $21.38
| Professional | | $8.13 | $11.48 | $21.38 |