- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $147.91 / $8,317.64
| Facility | | $85.11 | $147.91 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $74.13 / $125.89
| Professional | | $72.44 | $74.13 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $117.49 / $223.87
| Facility | | $81.28 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $81.28 / $91.20
| Professional | | $72.44 | $81.28 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $109.65 / $323.59
| Facility | | $74.13 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $89.13
| Professional | | $74.13 | $74.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $77.62 / $186.21
| Facility | | $74.13 | $77.62 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $81.28 / $190.55
| Professional | | $74.13 | $81.28 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $100.00
| Professional | | $70.79 | $81.28 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $138.04
| Facility | | $75.86 | $75.86 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $69.18 / $102.33 / $245.47
| Facility | | $69.18 | $102.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $117.49 / $239.88
| Facility | | $79.43 | $117.49 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $81.28 / $89.13
| Professional | | $74.13 | $81.28 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $74.13
| Facility | | $74.13 | $74.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $75.86 / $83.18
| Professional | | $74.13 | $75.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $95.50
| Professional | | $74.13 | $74.13 | $95.50 |