- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $616.60
| Facility | | $144.54 | $144.54 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.76 / $70.79
| Professional | | $0.63 | $0.76 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.11 / $0.14 / $0.35
| Facility | | $0.11 | $0.14 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.14 / $0.28
| Professional | | $0.14 | $0.14 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $18.20 / $31.62
| Professional | | $12.30 | $18.20 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.30 / $0.30
| Professional | | $0.30 | $0.30 | $0.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $154.88
| Professional | | $1.00 | $1.00 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $1.86 / $1.86
| Professional | | $1.86 | $1.86 | $1.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.28 / $0.28
| Professional | | $0.28 | $0.28 | $0.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $70.79
| Professional | | $54.95 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.16 / $0.30
| Facility | | $0.15 | $0.16 | $0.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.30 / $0.30
| Professional | | $0.18 | $0.30 | $0.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.37 / $0.69
| Professional | | $0.12 | $0.37 | $0.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.30 / $1.20
| Professional | | $0.22 | $0.30 | $1.20 |