- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $93.33 / $281.84
| Facility | | $33.11 | $93.33 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $20.89 / $35.48
| Professional | | $19.95 | $20.89 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $114.82
| Facility | | $26.92 | $26.92 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $20.89
| Professional | | $13.18 | $13.18 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $190.55
| Professional | | $81.28 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $69.18 / $123.03
| Facility | | $27.54 | $69.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $19.05 / $31.62
| Professional | | $13.49 | $19.05 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $40.74
| Professional | | $26.92 | $32.36 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $38.90
| Professional | | $27.54 | $27.54 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.92
| Facility | | $19.95 | $19.95 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $57.54
| Professional | | $21.38 | $21.38 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $10,000.00
| Facility | | $19.95 | $35.48 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $35.48 / $10,000.00
| Professional | | $19.95 | $35.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $26.92 / $33.11
| Facility | | $11.48 | $26.92 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.48 / $13.49 / $27.54
| Professional | | $11.48 | $13.49 | $27.54 |