- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $63.10
| Facility | | $46.77 | $46.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $25.12 / $52.48
| Professional | | $19.95 | $25.12 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $40.74
| Professional | 25 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $39.81 / $70.79
| Professional | | $22.91 | $39.81 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $40.74 / $56.23
| Professional | | $23.99 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $50.12 / $100.00
| Professional | | $28.18 | $50.12 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $34.67 / $54.95
| Facility | | $22.39 | $34.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $181.97
| Professional | | $30.90 | $53.70 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $51.29 / $60.26
| Professional | | $39.81 | $51.29 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $56.23 / $66.07
| Professional | | $47.86 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $74.13
| Professional | | $42.66 | $42.66 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.03 / $0.03 / $38.02
| Facility | | $0.03 | $0.03 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $67.61
| Professional | | $27.54 | $42.66 | $67.61 |