- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $89.13 / $213.80
| Facility | | $37.15 | $89.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $38.02
| Professional | | $28.18 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $56.23 / $75.86
| Facility | | $39.81 | $56.23 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $38.02
| Professional | | $28.18 | $33.88 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $79.43 / $120.23
| Facility | | $38.90 | $79.43 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $39.81 / $58.88
| Professional | | $23.44 | $39.81 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $64.57
| Professional | | $23.99 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $75.86
| Facility | | $38.02 | $38.02 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $45.71
| Professional | | $38.02 | $38.02 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $117.49
| Facility | | $38.02 | $66.07 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $45.71
| Professional | | $33.88 | $33.88 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $56.23 / $100.00
| Facility | | $43.65 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $33.88 / $38.02
| Professional | | $28.18 | $33.88 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $45.71
| Facility | | $33.88 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $45.71
| Professional | | $15.85 | $21.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $19.50 / $67.61
| Professional | | $16.98 | $19.50 | $67.61 |