- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $50.12 / $134.90
| Facility | | $12.88 | $50.12 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $14.13 / $22.39
| Professional | | $12.88 | $14.13 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $77.62
| Facility | | $18.20 | $18.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $9.12 / $14.13
| Professional | | $9.12 | $9.12 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $128.82
| Professional | | $54.95 | $87.10 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $47.86 / $83.18
| Facility | | $18.62 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $13.49 / $30.90
| Professional | | $10.23 | $13.49 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $21.88 / $26.92
| Professional | | $18.20 | $21.88 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $30.90 / $36.31
| Professional | | $15.14 | $30.90 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $19.95 / $19.95
| Facility | | $15.85 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.38 / $38.90
| Professional | | $15.85 | $21.38 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.92 / $10,000.00
| Facility | | $14.45 | $26.92 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $26.30 / $10,000.00
| Professional | | $14.45 | $26.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $18.20 / $31.62
| Facility | | $7.76 | $18.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $10.96 / $20.42
| Professional | | $7.76 | $10.96 | $20.42 |