- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $151.36 / $302.00
| Facility | | $34.67 | $151.36 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $60.26 / $75.86
| Professional | | $8.91 | $60.26 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $338.84
| Facility | | $81.28 | $81.28 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $32.36 / $53.70
| Professional | | $31.62 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $40.74 / $60.26
| Professional | | $25.70 | $40.74 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $52.48 / $363.08
| Facility | | $21.88 | $52.48 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.62 / $39.81 / $81.28
| Professional | | $5.62 | $39.81 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $120.23
| Professional | | $81.28 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $14.45 / $16.98
| Professional | | $7.08 | $14.45 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $58.88 / $64.57
| Facility | | $7.59 | $58.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $16.22 / $169.82
| Professional | | $7.59 | $16.22 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $95.50 / $10,000.00
| Facility | | $13.49 | $95.50 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $95.50 / $10,000.00
| Professional | | $13.49 | $95.50 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $81.28 / $95.50
| Facility | | $7.59 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.01 / $19.50 / $47.86
| Professional | | $5.01 | $19.50 | $47.86 |