- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $48.98 / $239.88
| Facility | | $26.92 | $48.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $107.15
| Professional | | $25.12 | $47.86 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $87.10
| Professional | | $35.48 | $38.90 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $41.69
| Facility | | $34.67 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $58.88 / $100.00
| Professional | | $31.62 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.20 / $54.95
| Professional | | $21.88 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $79.43
| Professional | | $54.95 | $54.95 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $45.71 / $64.57
| Facility | | $26.92 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $37.15 / $53.70
| Professional | | $24.55 | $37.15 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $16.98
| Facility | AS | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $316.23 / $316.23 / $426.58
| Professional | | $316.23 | $316.23 | $426.58 |