- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $57.54 / $75.86
| Facility | | $26.92 | $57.54 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $48.98
| Professional | | $26.92 | $26.92 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $60.26 / $102.33
| Facility | | $29.51 | $60.26 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $50.12
| Professional | | $29.51 | $29.51 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $30.20
| Professional | | $27.54 | $27.54 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $48.98 / $74.13
| Facility | | $29.51 | $48.98 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $29.51 / $95.50
| Professional | | $25.12 | $29.51 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $107.15
| Facility | | $27.54 | $30.20 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $100.00
| Professional | | $27.54 | $27.54 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $100.00
| Facility | | $28.18 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $100.00
| Professional | | $28.18 | $38.90 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $29.51 / $75.86
| Facility | | $28.84 | $29.51 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $28.84 / $32.36
| Professional | | $27.54 | $28.84 | $32.36 |