- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $131.83 / $218.78
| Facility | | $70.79 | $131.83 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $5.89 / $1,548.82
| Professional | | $0.63 | $5.89 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $186.21
| Facility | | $45.71 | $104.71 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.51 / $28.18 / $57.54
| Facility | | $0.51 | $28.18 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.31 / $0.42 / $0.78
| Professional | | $0.31 | $0.42 | $0.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.39 / $0.71
| Facility | | $0.30 | $0.39 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $1.00 / $6.17
| Professional | | $0.32 | $1.00 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $33.11
| Professional | | $30.20 | $30.20 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.39 / $0.69
| Facility | | $0.30 | $0.39 | $0.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.42 / $0.76
| Professional | | $0.30 | $0.42 | $0.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $81.28 / $97.72
| Facility | | $70.79 | $81.28 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $17.38 / $66.07
| Professional | | $0.34 | $17.38 | $66.07 |