- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $154.88 / $302.00
| Facility | | $35.48 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $21.88 / $42.66
| Professional | | $19.05 | $21.88 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $109.65
| Facility | | $25.70 | $25.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $12.88 / $19.95
| Professional | | $12.88 | $12.88 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $120.23 / $181.97
| Professional | | $75.86 | $120.23 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $67.61 / $117.49
| Facility | | $26.30 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.50 / $38.90
| Professional | | $14.13 | $19.50 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $38.02
| Professional | | $25.70 | $30.90 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $43.65 / $50.12
| Professional | | $21.38 | $43.65 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $24.55
| Facility | | $22.39 | $22.39 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $22.39 / $53.70
| Professional | | $21.88 | $22.39 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $42.66 / $10,000.00
| Facility | | $22.91 | $42.66 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $43.65 / $10,000.00
| Professional | | $22.91 | $43.65 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $25.70 / $44.67
| Facility | | $12.88 | $25.70 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $15.49 / $28.18
| Professional | | $10.96 | $15.49 | $28.18 |