- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $89.13 / $338.84
| Facility | | $26.92 | $89.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $28.84 / $58.88
| Professional | | $26.92 | $28.84 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $154.88
| Facility | | $36.31 | $36.31 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $28.18
| Professional | | $18.20 | $18.20 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $398.11
| Professional | | $165.96 | $288.40 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $144.54 / $204.17
| Facility | | $37.15 | $144.54 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $34.67 / $97.72
| Professional | | $19.95 | $34.67 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $43.65 / $53.70
| Professional | | $36.31 | $43.65 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $109.65
| Professional | | $46.77 | $95.50 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $38.02 / $47.86
| Facility | | $36.31 | $38.02 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $77.62 / $112.20
| Professional | | $47.86 | $77.62 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $75.86 / $10,000.00
| Facility | | $28.18 | $75.86 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $75.86 / $10,000.00
| Professional | | $28.18 | $75.86 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $36.31 / $97.72
| Facility | | $15.49 | $36.31 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $33.11 / $58.88
| Professional | | $15.49 | $33.11 | $58.88 |