- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $7.41
| Facility | | $3.98 | $5.01 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $7.94
| Professional | | $3.98 | $5.01 | $7.94 |
- 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
- $9.55 / $9.55 / $9.55
| Professional | | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $5.75
| Facility | | $5.75 | $5.75 | $5.75 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $4.90 / $4.90
| Professional | | $4.90 | $4.90 | $4.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.71 / $14.13 / $21.38
| Professional | | $8.71 | $14.13 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $9.77 / $9.77
| Facility | | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $9.77
| Professional | | $5.89 | $5.89 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $3.98 / $5.01
| Facility | | $3.98 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.98 / $5.01 / $7.94
| Professional | | $3.98 | $5.01 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $13.18 / $19.05
| Professional | | $0.60 | $13.18 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.92 / $6.92 / $12.30
| Facility | | $6.92 | $6.92 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $8.71 / $16.60
| Professional | | $4.90 | $8.71 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.72 / $4.79 / $8.51
| Professional | | $3.72 | $4.79 | $8.51 |