- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $107.15 / $218.78
| Facility | | $81.28 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $138.04
| Professional | | $81.28 | $83.18 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $85.11
| Facility | | $81.28 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $107.15 / $123.03
| Facility | | $89.13 | $107.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $346.74
| Professional | | $81.28 | $81.28 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $93.33 / $275.42
| Facility | | $75.86 | $93.33 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $102.33
| Professional | | $77.62 | $77.62 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $85.11
| Facility | | $81.28 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $83.18
| Professional | | $81.28 | $81.28 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $50,118.72 / $75,857.76
| Facility | | $102.33 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $81.28 / $128.82
| Facility | | $77.62 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $81.28 / $134.90
| Professional | | $72.44 | $81.28 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $93.33
| Facility | | $81.28 | $81.28 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $97.72
| Professional | | $81.28 | $83.18 | $97.72 |