- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $4.57 / $4.57
| Facility | | $2.00 | $4.57 | $4.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $5.01
| Professional | | $2.00 | $3.02 | $5.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Professional | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.80 / $3.80 / $6.03
| Facility | | $3.80 | $3.80 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.45 / $3.24 / $3.24
| Professional | | $2.45 | $3.24 | $3.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $7.76 / $11.48
| Professional | | $5.50 | $7.76 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.03 / $6.03 / $6.03
| Facility | | $6.03 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $4.17 / $6.03
| Professional | | $3.63 | $4.17 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $2.00 / $2.00
| Facility | | $2.00 | $2.00 | $2.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $5.01
| Professional | | $2.00 | $3.02 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $8.32 / $11.48
| Professional | | $0.60 | $8.32 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $28.18
| Facility | | $4.17 | $4.17 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $5.62 / $28.18
| Professional | | $4.17 | $5.62 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $2.45 / $3.72
| Facility | | $1.95 | $2.45 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.04 / $2.95 / $6.03
| Professional | | $2.04 | $2.95 | $6.03 |