- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $97.72 / $588.84
| Facility | | $26.30 | $97.72 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $17.78 / $44.67
| Professional | | $16.98 | $17.78 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $100.00
| Facility | | $23.44 | $23.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $16.22
| Professional | | $9.77 | $9.77 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $93.33 / $138.04
| Professional | | $58.88 | $93.33 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $48.98 / $107.15
| Facility | | $23.99 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.45 / $33.88
| Professional | | $11.75 | $14.45 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.18 / $34.67
| Professional | | $23.44 | $28.18 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $33.11 / $38.90
| Professional | | $16.22 | $33.11 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $20.42
| Facility | | $17.78 | $17.78 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $48.98
| Professional | | $20.42 | $28.18 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.90 / $10,000.00
| Facility | | $17.38 | $30.90 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.90 / $10,000.00
| Professional | | $17.38 | $30.90 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $23.44 / $33.88
| Facility | | $10.00 | $23.44 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $12.02 / $23.44
| Professional | | $10.00 | $12.02 | $23.44 |