- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $66.07 / $117.49
| Facility | | $21.88 | $66.07 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $22.91 / $34.67
| Professional | | $18.20 | $22.91 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $125.89
| Facility | | $29.51 | $29.51 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $12.02 / $20.89
| Professional | | $12.02 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $66.07 / $141.25
| Professional | | $23.99 | $66.07 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $57.54 / $134.90
| Facility | | $34.67 | $57.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.20 / $45.71
| Professional | | $13.49 | $18.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $42.66
| Professional | | $29.51 | $35.48 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $38.02 / $61.66
| Facility | | $24.55 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $63.10
| Professional | | $19.50 | $19.50 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $35.48 / $10,000.00
| Facility | | $25.12 | $35.48 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $35.48 / $10,000.00
| Professional | | $22.39 | $35.48 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $29.51 / $35.48
| Facility | | $16.98 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $14.79 / $32.36
| Professional | | $11.75 | $14.79 | $32.36 |