- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $100.00 / $724.44
| Facility | | $15.49 | $100.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $95.50 / $186.21
| Professional | | $29.51 | $95.50 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.33 / $0.34
| Professional | | $0.26 | $0.33 | $0.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.28 / $0.51 / $1.95
| Professional | | $0.28 | $0.51 | $1.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.48 / $3.16
| Facility | | $0.32 | $0.48 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.62
| Professional | | $0.26 | $0.26 | $0.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $0.36 / $0.48
| Professional | | $0.32 | $0.36 | $0.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.39
| Professional | | $0.35 | $0.35 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $1,862.09 / $5,248.07
| Facility | | $338.84 | $1,862.09 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.30 / $0.49 / $0.65
| Professional | | $0.30 | $0.49 | $0.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.43 / $0.43 / $0.43
| Facility | | $0.43 | $0.43 | $0.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.27 / $0.28 / $0.35
| Professional | | $0.27 | $0.28 | $0.35 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.22 / $0.28 / $0.28
| Professional | | $0.22 | $0.28 | $0.28 |