- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $117.49 / $213.80
| Facility | | $42.66 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $44.67 / $69.18
| Professional | | $18.20 | $44.67 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $57.54 / $245.47
| Facility | | $57.54 | $57.54 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $39.81
| Professional | | $23.44 | $23.44 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $66.07 / $141.25
| Professional | | $46.77 | $66.07 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $79.43 / $263.03
| Facility | | $47.86 | $79.43 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $33.88 / $57.54
| Professional | | $13.49 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $63.10 / $81.28
| Professional | | $54.95 | $63.10 | $81.28 |
- 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
- $34.67 / $52.48 / $91.20
| Facility | | $34.67 | $52.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $21.38 / $123.03
| Professional | | $21.38 | $21.38 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $66.07 / $10,000.00
| Facility | | $28.18 | $66.07 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $69.18 / $10,000.00
| Professional | | $28.18 | $69.18 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $57.54 / $69.18
| Facility | | $17.38 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $25.70 / $48.98
| Professional | | $11.75 | $25.70 | $48.98 |