- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $54.95 / $208.93
| Facility | | $19.05 | $54.95 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $16.60 / $21.88
| Professional | | $12.88 | $16.60 | $21.88 |
- 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 / $16.60 / $17.38
| Facility | | $15.85 | $16.60 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $38.90
| Professional | | $15.85 | $26.92 | $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 / $26.92 / $10,000.00
| Professional | | $14.45 | $26.92 | $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 / $19.50
| Professional | | $7.76 | $10.96 | $19.50 |