- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.98 / $5.75
| Facility | | $2.00 | $3.98 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.02 / $4.07
| Professional | | $2.00 | $3.02 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.24 / $2.24 / $7.24
| Professional | | $2.24 | $2.24 | $7.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.89 / $4.17 / $4.17
| Facility | | $3.89 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Professional | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $8.13 / $53,703.18
| Facility | | $8.13 | $8.13 | $53,703.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.57 / $2.57 / $5.37
| Professional | | $2.57 | $2.57 | $5.37 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.13 / $8.51 / $19.50
| Facility | | $5.13 | $8.51 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.57 / $7.41 / $10.23
| Professional | | $4.57 | $7.41 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.82
| Facility | | $1.70 | $1.70 | $1.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.95 / $3.09
| Professional | | $1.70 | $2.95 | $3.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $50,118.72 / $75,857.76
| Facility | | $3.72 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.39 / $4.90 / $4.90
| Professional | | $3.39 | $4.90 | $4.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $14.45 / $19.05
| Facility | | $14.45 | $14.45 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.14 / $4.47 / $9.33
| Professional | | $2.14 | $4.47 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.88 / $2.95
| Facility | | $1.70 | $2.88 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $2.95 / $3.09
| Professional | | $1.70 | $2.95 | $3.09 |