- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $40.74 / $95.50
| Facility | | $14.13 | $40.74 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $15.14 / $19.95
| Professional | | $14.13 | $15.14 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $83.18
| Facility | | $19.50 | $19.50 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $14.13
| Professional | | $9.55 | $9.55 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $91.20 / $134.90
| Professional | | $57.54 | $91.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $47.86 / $87.10
| Facility | | $19.50 | $47.86 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $14.13 / $33.11
| Professional | | $10.72 | $14.13 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $28.84
| Professional | | $19.50 | $23.44 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $32.36 / $38.02
| Professional | | $11.75 | $32.36 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $18.20
| Facility | | $17.38 | $17.38 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.18 / $40.74
| Professional | | $17.38 | $28.18 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $10,000.00
| Facility | | $15.14 | $26.92 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $26.92 / $10,000.00
| Professional | | $15.14 | $26.92 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $19.50 / $33.11
| Facility | | $8.13 | $19.50 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $11.48 / $20.42
| Professional | | $8.13 | $11.48 | $20.42 |