- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $51.29 / $446.68
| Facility | | $2.57 | $51.29 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.00 / $6.76
| Professional | | $1.00 | $1.00 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.10 / $1.12 / $2.57
| Professional | | $1.10 | $1.12 | $2.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $4.07 / $8.51
| Facility | | $1.66 | $4.07 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $1.66 / $1.66
| Professional | | $1.66 | $1.66 | $1.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Facility | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.62 / $3.63 / $9.77
| Facility | | $1.62 | $3.63 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- 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
- $8.91 / $8.91 / $22.39
| Professional | | $8.91 | $8.91 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $5.62 / $363.08
| Facility | | $1.45 | $5.62 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.00 / $1.45 / $3.09
| Professional | | $1.00 | $1.45 | $3.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.02 / $1.02 / $1.02
| Professional | | $1.02 | $1.02 | $1.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $660.69 / $660.69
| Facility | | $407.38 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $2.04 / $4.57
| Facility | | $1.45 | $2.04 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.58 / $2.45 / $2.63
| Facility | | $1.58 | $2.45 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.51
| Professional | | $1.45 | $1.45 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.45 / $1.45 / $1.45
| Professional | | $1.45 | $1.45 | $1.45 |