- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $36.31 / $100.00
| Facility | | $22.91 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.99 / $41.69
| Professional | | $19.05 | $23.99 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.39 / $30.90
| Professional | | $16.98 | $22.39 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.90 / $123.03
| Professional | | $25.70 | $30.90 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $204.17
| Facility | | $53.70 | $72.44 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $29.51 / $61.66
| Professional | | $23.99 | $29.51 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $44.67
| Professional | | $30.20 | $36.31 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $39.81 / $42.66
| Professional | | $33.88 | $39.81 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $31.62 / $53.70
| Facility | | $21.88 | $31.62 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $158.49
| Facility | | $22.91 | $38.02 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $158.49
| Professional | | $22.91 | $38.02 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $37.15 / $38.02
| Facility | | $33.11 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $43.65
| Professional | | $23.44 | $33.11 | $43.65 |