- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $812.83 / $4,786.30
| Facility | | $117.49 | $812.83 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.82 / $2.82
| Professional | | $2.24 | $2.82 | $2.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $3.47 / $6.61
| Facility | | $1.41 | $3.47 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.20
| Professional | | $0.20 | $0.20 | $0.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.33 / $7.59
| Facility | | $0.33 | $0.33 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.31 / $0.81
| Facility | | $0.14 | $0.31 | $0.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $794.33 / $3,981.07
| Facility | | $1.95 | $794.33 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.59 / $2.82
| Professional | | $0.12 | $0.59 | $2.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.16 / $0.16 / $0.17
| Professional | | $0.16 | $0.16 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.14 / $0.23 / $1.02
| Facility | | $0.14 | $0.23 | $1.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.12 / $0.12 / $0.12
| Professional | | $0.12 | $0.12 | $0.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.18 / $0.25 / $0.25
| Facility | | $0.18 | $0.25 | $0.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.16 / $0.16
| Professional | | $0.15 | $0.16 | $0.16 |