- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $77.62 / $131.83
| Facility | | $25.70 | $77.62 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $25.70 / $33.11
| Professional | | $16.98 | $25.70 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $147.91
| Facility | | $35.48 | $35.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $23.44
| Professional | | $14.13 | $14.13 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $79.43 / $120.23
| Professional | | $50.12 | $79.43 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $58.88 / $158.49
| Facility | | $35.48 | $58.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $17.38 / $34.67
| Professional | | $12.02 | $17.38 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $52.48
| Professional | | $35.48 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $25.70
| Professional | | $18.62 | $18.62 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $31.62
| Facility | | $25.70 | $25.70 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $74.13
| Professional | | $18.20 | $18.20 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $41.69 / $10,000.00
| Facility | | $18.62 | $41.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $41.69 / $10,000.00
| Professional | | $18.62 | $41.69 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $35.48 / $41.69
| Facility | | $11.22 | $35.48 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $14.79 / $20.89
| Professional | | $7.76 | $14.79 | $20.89 |