- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $66.07 / $186.21
| Facility | | $19.95 | $66.07 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $23.44 / $66.07
| Professional | | $17.38 | $23.44 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $114.82
| Facility | | $26.92 | $26.92 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $13.18 / $20.42
| Professional | | $13.18 | $13.18 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $128.82 / $190.55
| Professional | | $81.28 | $128.82 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $63.10 / $123.03
| Facility | | $27.54 | $63.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $17.78 / $38.90
| Professional | | $14.79 | $17.78 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $39.81
| Professional | | $26.92 | $32.36 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $52.48
| Professional | | $44.67 | $44.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $27.54
| Facility | | $24.55 | $24.55 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $27.54 / $56.23
| Professional | | $21.38 | $27.54 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $10,000.00
| Facility | | $22.39 | $37.15 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $37.15 / $10,000.00
| Professional | | $22.39 | $37.15 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $26.92 / $45.71
| Facility | | $11.22 | $26.92 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.22 / $28.18
| Professional | | $11.22 | $16.22 | $28.18 |