- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $47.86 / $158.49
| Facility | | $15.14 | $47.86 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.85 / $20.89
| Professional | | $15.14 | $15.85 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $87.10
| Facility | | $20.42 | $20.42 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $10.00 / $15.85
| Professional | | $10.00 | $10.00 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $95.50 / $144.54
| Professional | | $60.26 | $95.50 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $50.12 / $91.20
| Facility | | $20.89 | $50.12 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $15.14 / $35.48
| Professional | | $11.22 | $15.14 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $30.20
| Professional | | $20.42 | $24.55 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $33.88 / $39.81
| Professional | | $16.98 | $33.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.62 / $19.50
| Facility | | $18.20 | $18.62 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $42.66
| Professional | | $18.20 | $26.92 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $34.67 / $10,000.00
| Facility | | $18.20 | $34.67 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $35.48 / $10,000.00
| Professional | | $18.20 | $35.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $20.42 / $35.48
| Facility | | $8.51 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $12.30 / $22.39
| Professional | | $8.51 | $12.30 | $22.39 |