- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $79.43 / $537.03
| Facility | | $25.70 | $79.43 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.20 / $63.10
| Professional | | $22.91 | $30.20 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $147.91
| Facility | | $34.67 | $34.67 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $32.36
| Professional | | $18.20 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $107.15 / $223.87
| Professional | | $27.54 | $107.15 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $81.28 / $158.49
| Facility | | $54.95 | $81.28 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $66.07
| Professional | | $17.78 | $25.70 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $51.29
| Professional | | $34.67 | $41.69 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $57.54 / $87.10
| Facility | | $31.62 | $57.54 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $72.44
| Professional | | $25.70 | $25.70 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $48.98 / $10,000.00
| Facility | | $32.36 | $48.98 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $50.12 / $10,000.00
| Professional | | $32.36 | $50.12 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $34.67 / $54.95
| Facility | | $26.92 | $34.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $34.67 / $72.44
| Professional | | $20.89 | $34.67 | $72.44 |