- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $100.00 / $134.90
| Facility | | $38.02 | $100.00 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $46.77 / $64.57
| Professional | | $30.90 | $46.77 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $43.65 / $213.80
| Facility | | $37.15 | $43.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $42.66 / $43.65
| Professional | | $41.69 | $42.66 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $28.84
| Facility | | $28.84 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $50.12 / $51.29
| Professional | | $39.81 | $50.12 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $67.61 / $190.55
| Facility | | $21.88 | $67.61 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $46.77 / $51.29
| Professional | | $42.66 | $46.77 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,148.15 / $1,230.27 / $1,348.96
| Facility | | $1,148.15 | $1,230.27 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $41.69 / $89.13
| Facility | | $33.88 | $41.69 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $53.70
| Professional | | $43.65 | $50.12 | $53.70 |