- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $100.00 / $20,892.96
| Facility | | $67.61 | $100.00 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $66.07 / $87.10
| Professional | | $64.57 | $66.07 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $147.91
| Facility | | $83.18 | $83.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $85.11
| Professional | | $66.07 | $66.07 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $100.00 / $181.97
| Facility | | $83.18 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $83.18 / $134.90
| Professional | | $66.07 | $83.18 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $66.07 / $72.44
| Facility | | $60.26 | $66.07 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $151.36
| Professional | | $70.79 | $131.83 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $72.44
| Facility | | $64.57 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $72.44 / $281.84
| Professional | | $64.57 | $72.44 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $58.88 / $70.79
| Professional | | $32.36 | $58.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $66.07 / $67.61
| Facility | | $63.10 | $66.07 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $67.61 / $112.20
| Professional | | $51.29 | $67.61 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $107.15 / $199.53
| Professional | | $66.07 | $107.15 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $97.72 / $331.13
| Facility | | $66.07 | $97.72 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $114.82 / $281.84
| Professional | | $66.07 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $81.28 / $109.65
| Professional | | $51.29 | $81.28 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $151.36
| Facility | | $64.57 | $64.57 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $69.18 / $75.86
| Professional | | $66.07 | $69.18 | $75.86 |