- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $162.18 / $25,703.96
| Facility | | $83.18 | $162.18 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $83.18 / $177.83
| Professional | | $81.28 | $83.18 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $213.80
| Facility | | $63.10 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $100.00
| Professional | | $81.28 | $89.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $251.19
| Facility | | $81.28 | $123.03 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $100.00
| Professional | | $81.28 | $81.28 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $81.28 / $173.78
| Facility | | $67.61 | $81.28 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $154.88
| Professional | | $64.57 | $81.28 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $97.72
| Professional | | $70.79 | $81.28 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $162.18
| Facility | | $79.43 | $79.43 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $239.88
| Facility | | $64.57 | $85.11 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $83.18 / $91.20
| Professional | | $83.18 | $83.18 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $95.50 / $229.09
| Facility | | $63.10 | $95.50 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $100.00
| Professional | | $81.28 | $89.13 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Facility | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $81.28 / $89.13
| Professional | | $75.86 | $81.28 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $81.28 / $107.15
| Professional | | $74.13 | $81.28 | $107.15 |