- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $66.07 / $165.96
| Facility | | $21.88 | $66.07 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $23.99 / $28.84
| Professional | | $21.88 | $23.99 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $128.82
| Facility | | $30.20 | $30.20 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $13.80 / $22.91
| Professional | | $13.80 | $13.80 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $141.25 / $194.98
| Professional | | $83.18 | $141.25 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $43.65
| Professional | | $34.67 | $34.67 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $44.67
| Professional | | $30.20 | $36.31 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $54.95
| Professional | | $22.91 | $46.77 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $25.12 / $26.92
| Facility | | $23.44 | $25.12 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $56.23 / $63.10
| Professional | | $23.44 | $56.23 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $10,000.00
| Facility | | $21.88 | $40.74 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $10,000.00
| Professional | | $21.88 | $40.74 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $30.20 / $47.86
| Facility | | $12.59 | $30.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $16.98 / $33.11
| Professional | | $12.59 | $16.98 | $33.11 |