- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $70.79 / $204.17
| Facility | | $25.12 | $70.79 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $26.92 / $39.81
| Professional | | $25.12 | $26.92 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $144.54
| Facility | | $33.88 | $33.88 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $16.60 / $26.30
| Professional | | $16.60 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $158.49 / $239.88
| Professional | | $100.00 | $158.49 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $89.13 / $154.88
| Facility | | $34.67 | $89.13 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $51.29
| Professional | | $18.62 | $25.12 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $40.74 / $50.12
| Professional | | $33.88 | $40.74 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $57.54 / $66.07
| Professional | | $28.18 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $32.36
| Facility | | $28.84 | $29.51 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $28.84 / $70.79
| Professional | | $12.30 | $28.84 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $48.98 / $10,000.00
| Facility | | $26.30 | $48.98 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $48.98 / $10,000.00
| Professional | | $26.30 | $48.98 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $33.88 / $58.88
| Facility | | $14.13 | $33.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $20.42 / $35.48
| Professional | | $14.13 | $20.42 | $35.48 |