- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $1,000.00 / $2,398.83
| Facility | | $75.86 | $1,000.00 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.41 / $114.82 / $186.21
| Professional | | $1.41 | $114.82 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.91 / $2.29 / $4.27
| Facility | | $0.91 | $2.29 | $4.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.34 / $0.34 / $0.34
| Professional | | $0.34 | $0.34 | $0.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.37 / $4.37 / $4.37
| Facility | | $4.37 | $4.37 | $4.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.42 / $0.81 / $2.19
| Facility | | $0.42 | $0.81 | $2.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.35
| Professional | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Facility | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $257.04 / $2,041.74
| Facility | | $0.35 | $257.04 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $1.41 / $173.78
| Professional | | $0.35 | $1.41 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.46
| Professional | | $0.35 | $0.35 | $0.46 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.50 / $1.12
| Facility | | $0.35 | $0.50 | $1.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.35 / $0.35
| Professional | | $0.35 | $0.35 | $0.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.33 / $0.35 / $0.54
| Facility | | $0.33 | $0.35 | $0.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $0.37 / $0.39
| Professional | | $0.35 | $0.37 | $0.39 |