- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $5.25 / $5.25
| Facility | | $5.25 | $5.25 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.80 / $26.92
| Professional | | $3.02 | $3.80 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.17 / $4.17 / $4.17
| Facility | | $4.17 | $4.17 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $3.55 / $3.55
| Professional | | $3.55 | $3.55 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.79 / $12.30 / $15.14
| Professional | | $4.79 | $12.30 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.62 / $5.62 / $6.46
| Facility | | $0.62 | $5.62 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.75 / $6.17 / $6.92
| Professional | | $5.75 | $6.17 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $6.31 / $6.92
| Facility | | $0.63 | $6.31 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.63 / $0.98 / $7.08
| Professional | | $0.63 | $0.98 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.31 / $6.61 / $2,691,534.80
| Facility | | $3.31 | $6.61 | $2,691,534.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.55 / $4.17 / $79.43
| Professional | | $3.55 | $4.17 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $9.33 / $21.88
| Facility | | $6.46 | $9.33 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.68 / $6.46 / $7.08
| Professional | | $4.68 | $6.46 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.35 / $3.24 / $4.47
| Facility | | $0.35 | $3.24 | $4.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $3.31 / $5.89
| Professional | | $3.02 | $3.31 | $5.89 |