- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $102.33 / $204.17
| Facility | | $33.88 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $46.77
| Professional | | $30.90 | $33.88 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $194.98
| Facility | | $46.77 | $46.77 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $30.90
| Professional | | $18.62 | $18.62 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $162.18 / $239.88
| Professional | | $102.33 | $162.18 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $91.20 / $208.93
| Facility | | $46.77 | $91.20 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $27.54 / $53.70
| Professional | | $22.39 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $54.95 / $69.18
| Professional | | $46.77 | $54.95 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $66.07
| Professional | | $57.54 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $39.81
| Facility | | $33.88 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $97.72
| Professional | | $28.84 | $38.90 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $10,000.00
| Facility | | $33.88 | $57.54 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $57.54 / $10,000.00
| Professional | | $33.88 | $57.54 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $46.77 / $58.88
| Facility | | $19.50 | $46.77 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $21.38 / $46.77
| Professional | | $19.50 | $21.38 | $46.77 |