- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $426.58 / $758.58
| Facility | | $169.82 | $426.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.17 / $1.91 / $2,089.30
| Professional | | $1.17 | $1.91 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $1.07 / $2.69
| Facility | | $0.32 | $1.07 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.95
| Professional | | $0.35 | $0.35 | $0.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.71
| Facility | | $0.35 | $0.35 | $0.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.63 / $1.51
| Facility | | $0.35 | $0.63 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.81
| Professional | | $0.35 | $0.35 | $0.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.60 / $6,918.31
| Facility | | $0.35 | $0.60 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.46 / $0.46 / $0.54
| Professional | | $0.46 | $0.46 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.71
| Professional | | $0.35 | $0.35 | $0.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $288.40
| Facility | | $190.55 | $190.55 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.32 / $1.07 / $2.69
| Facility | | $0.32 | $1.07 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.95
| Professional | | $0.35 | $0.35 | $0.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.49 / $190.55 / $870.96
| Facility | | $0.49 | $190.55 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.35 / $0.71
| Facility | | $0.33 | $0.35 | $0.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.95
| Professional | | $0.35 | $0.35 | $0.95 |