- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $28.18 / $177.83
| Facility | | $15.85 | $28.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $28.84 / $87.10
| Professional | | $16.22 | $28.84 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $20.89 / $51.29
| Facility | | $16.22 | $20.89 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $31.62 / $77.62
| Professional | | $18.20 | $31.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $100.00 / $100.00
| Facility | | $77.62 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $64.57
| Professional | | $17.38 | $26.92 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $63.10
| Professional | | $19.50 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $20.89 / $40.74
| Professional | | $16.60 | $20.89 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $27.54 / $51.29
| Professional | | $15.85 | $27.54 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $251.19
| Professional | | $234.42 | $234.42 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $38.90
| Professional | | $23.44 | $23.44 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $31.62 / $46.77
| Facility | | $19.95 | $31.62 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $67.61
| Professional | | $19.05 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $87.10
| Professional | | $61.66 | $61.66 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $44.67
| Facility | | $35.48 | $35.48 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $27.54 / $61.66
| Professional | | $17.38 | $27.54 | $61.66 |