- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $295.12 / $812.83
| Facility | | $64.57 | $295.12 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $181.97
| Professional | | $15.85 | $23.99 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $776.25 / $933.25
| Facility | | $602.56 | $776.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $11.75 / $19.95
| Professional | | $11.75 | $11.75 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $64.57
| Professional | | $26.92 | $46.77 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.29 / $44.67 / $114.82
| Facility | | $1.29 | $44.67 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $14.79 / $26.30
| Professional | | $8.51 | $14.79 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $28.18 / $29.51
| Professional | | $19.50 | $28.18 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $13.49 / $19.50
| Facility | | $13.49 | $13.49 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $11.48
| Professional | | $3.98 | $3.98 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $10,000.00
| Facility | | $17.38 | $34.67 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $10,000.00
| Professional | | $17.38 | $34.67 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $141.25 / $173.78
| Facility | | $8.13 | $141.25 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.12 / $14.45 / $19.95
| Professional | | $9.12 | $14.45 | $19.95 |