- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $95.50 / $223.87
| Facility | | $26.30 | $95.50 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $41.69
| Professional | | $22.91 | $26.30 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $147.91
| Facility | | $35.48 | $35.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $30.20
| Professional | | $17.38 | $17.38 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $117.49 / $251.19
| Professional | | $28.18 | $117.49 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $158.49
| Facility | | $54.95 | $87.10 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $26.30 / $69.18
| Professional | | $19.50 | $26.30 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $41.69 / $52.48
| Professional | | $35.48 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $69.18 / $69.18
| Professional | | $69.18 | $69.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $85.11
| Facility | | $31.62 | $57.54 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $74.13
| Professional | | $28.18 | $28.18 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $10,000.00
| Facility | | $35.48 | $48.98 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $48.98 / $10,000.00
| Professional | | $35.48 | $48.98 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $60.26
| Facility | | $29.51 | $35.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $20.89 / $46.77
| Professional | | $14.79 | $20.89 | $46.77 |