- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $75.86 / $251.19
| Facility | | $34.67 | $75.86 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $67.61
| Professional | | $19.05 | $32.36 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $51.29 / $70.79
| Facility | | $34.67 | $51.29 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $46.77
| Professional | | $29.51 | $34.67 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $79.43 / $102.33
| Facility | | $36.31 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $37.15 / $47.86
| Professional | | $17.78 | $37.15 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $109.65
| Facility | | $34.67 | $43.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $43.65 / $100.00
| Professional | | $34.67 | $43.65 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $75.86
| Professional | | $28.18 | $33.88 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $70.79
| Facility | | $34.67 | $34.67 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $41.69
| Professional | | $34.67 | $34.67 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $61.66 / $109.65
| Facility | | $34.67 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $41.69
| Professional | | $31.62 | $31.62 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $52.48 / $93.33
| Facility | | $39.81 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $46.77
| Professional | | $29.51 | $34.67 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $41.69 / $41.69
| Facility | | $34.67 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.79 / $14.79 / $38.90
| Professional | | $14.79 | $14.79 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $34.67 / $63.10
| Professional | | $15.85 | $34.67 | $63.10 |