- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.00 / $3.55 / $28.18
| Facility | | $2.00 | $3.55 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.70 / $1.70 / $1.70
| Professional | | $1.70 | $1.70 | $1.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $16.22 / $25.70
| Facility | | $8.91 | $16.22 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $0.25
| Professional | | $0.25 | $0.25 | $0.25 |
- 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
- $0.39 / $0.39 / $0.39
| Professional | | $0.39 | $0.39 | $0.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.23 / $0.23 / $0.23
| Facility | | $0.23 | $0.23 | $0.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.20 / $0.20
| Professional | | $0.20 | $0.20 | $0.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.36 / $0.58 / $0.87
| Professional | | $0.36 | $0.58 | $0.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.40 / $0.40 / $0.40
| Facility | | $0.40 | $0.40 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.20 / $0.24 / $0.40
| Professional | | $0.20 | $0.24 | $0.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.26 / $0.26 / $0.28
| Professional | | $0.26 | $0.26 | $0.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $14.79 / $22.39
| Facility | | $6.31 | $14.79 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.40 / $2.40 / $3.55
| Facility | | $2.40 | $2.40 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.50 / $0.60 / $0.79
| Professional | | $0.50 | $0.60 | $0.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.13 / $0.28 / $0.41
| Facility | | $0.13 | $0.28 | $0.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.21 / $0.35 / $0.42
| Professional | | $0.21 | $0.35 | $0.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.15 / $0.19 / $0.34
| Professional | | $0.15 | $0.19 | $0.34 |