- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $6.03 / $114.82
| Facility | | $1.00 | $6.03 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $1.86
| Professional | | $1.00 | $1.00 | $1.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $9.77 / $18.20
| Facility | | $3.89 | $9.77 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.70
| Professional | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $4.07 / $11.75
| Facility | | $1.74 | $4.07 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $416.87
| Professional | | $34.67 | $34.67 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $2.04 / $60.26
| Facility | | $1.62 | $2.04 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $2.00
| Professional | | $1.00 | $1.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $44.67
| Professional | | $30.20 | $30.20 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $2.04 / $13.18
| Facility | | $1.66 | $2.04 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $1.74 / $1.74
| Professional | | $1.74 | $1.74 | $1.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $17.78 / $17.78
| Facility | | $10.72 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.74 / $1.78
| Professional | | $1.70 | $1.74 | $1.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $3.89 / $3.89
| Professional | | $3.89 | $3.89 | $3.89 |