- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $398.11 / $630.96
| Facility | | $208.93 | $398.11 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $190.55 / $512.86
| Professional | | $154.88 | $190.55 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $537.03
| Facility | | $208.93 | $208.93 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $467.74
| Professional | | $102.33 | $102.33 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $208.93 / $208.93
| Facility | | $125.89 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $208.93 / $208.93
| Professional | | $151.36 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $446.68 / $758.58
| Facility | | $204.17 | $446.68 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $295.12 / $1,000.00
| Professional | | $141.25 | $295.12 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $208.93 / $575.44
| Facility | | $61.66 | $208.93 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $177.83 / $398.11
| Professional | | $147.91 | $177.83 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $199.53 / $371.54
| Professional | | $158.49 | $199.53 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $562.34
| Facility | | $208.93 | $245.47 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $398.11 / $50,118.72
| Facility | | $251.19 | $398.11 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $269.15
| Professional | | $208.93 | $208.93 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $251.19 / $338.84
| Facility | | $208.93 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $177.83 / $407.38
| Professional | | $87.10 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $177.83 / $234.42
| Facility | | $58.88 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $199.53 / $501.19
| Professional | | $141.25 | $199.53 | $501.19 |