- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.37 / $37.15 / $309.03
| Facility | | $5.37 | $37.15 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.07 / $1.38 / $4.90
| Professional | | $1.07 | $1.38 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $2.00 / $3.89
| Facility | | $0.40 | $2.00 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $22.39 / $56.23
| Facility | | $0.60 | $22.39 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $1.66 / $4.79
| Facility | | $0.71 | $1.66 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.71 / $0.71
| Professional | | $0.71 | $0.71 | $0.71 |
- 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
- $2.57 / $28.84 / $309.03
| Facility | | $2.57 | $28.84 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.59 / $1.26 / $3.39
| Professional | | $0.59 | $1.26 | $3.39 |
- 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
- $5,754.40 / $9,549.93 / $9,549.93
| Facility | | $5,754.40 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.83 / $2.24
| Facility | | $0.10 | $0.83 | $2.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.71 / $0.71
| Professional | | $0.71 | $0.71 | $0.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.75 / $2.75
| Facility | | $2.04 | $2.75 | $2.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.71 / $0.71 / $0.76
| Professional | | $0.71 | $0.71 | $0.76 |