- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $50.12 / $131.83
| Facility | | $19.05 | $50.12 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $20.89 / $25.12
| Professional | | $19.05 | $20.89 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $112.20
| Facility | | $26.92 | $26.92 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $20.42
| Professional | | $12.02 | $12.02 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $100.00 / $147.91
| Professional | | $63.10 | $100.00 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $60.26 / $120.23
| Facility | | $26.92 | $60.26 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $38.02
| Professional | | $13.49 | $18.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $39.81
| Professional | | $26.92 | $31.62 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $41.69 / $47.86
| Professional | | $17.78 | $41.69 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $22.39 / $23.99
| Facility | | $20.89 | $22.39 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $20.89 / $56.23
| Professional | | $16.98 | $20.89 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $10,000.00
| Facility | | $19.50 | $36.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $36.31 / $10,000.00
| Professional | | $19.50 | $36.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $42.66
| Facility | | $11.22 | $26.92 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $13.80 / $26.92
| Professional | | $11.22 | $13.80 | $26.92 |