- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $100.00 / $281.84
| Facility | | $40.74 | $100.00 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $53.70
| Professional | | $19.95 | $25.12 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $138.04
| Facility | | $25.70 | $39.81 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $69.18
| Professional | | $16.98 | $28.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $69.18 / $100.00
| Facility | | $54.95 | $69.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $34.67
| Professional | | $26.30 | $26.30 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $44.67 / $109.65
| Facility | | $21.88 | $44.67 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $32.36 / $72.44
| Professional | | $16.98 | $32.36 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $138.04 / $7,079.46
| Facility | | $25.12 | $138.04 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $47.86
| Professional | | $40.74 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $77.62
| Professional | | $28.18 | $28.18 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $95.50
| Facility | | $33.11 | $37.15 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $39.81 / $138.04
| Facility | | $25.70 | $39.81 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $28.18 / $69.18
| Professional | | $16.98 | $28.18 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $39.81 / $69.18
| Facility | | $28.18 | $39.81 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.18 / $41.69
| Professional | | $24.55 | $28.18 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $28.18 / $40.74
| Facility | | $14.13 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $75.86
| Professional | | $16.98 | $22.91 | $75.86 |