- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $15.85
| Professional | | $7.94 | $8.91 | $15.85 |
- 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
- $19.50 / $19.50 / $19.50
| Professional | | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $11.22 / $17.78
| Facility | | $11.22 | $11.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.55 / $9.55 / $11.22
| Professional | | $9.55 | $9.55 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $38.02
| Professional | | $18.20 | $26.30 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Facility | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $12.02 / $14.13 / $19.95
| Professional | | $12.02 | $14.13 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $15.85
| Professional | | $7.94 | $8.91 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.60 / $28.18 / $38.90
| Professional | | $0.60 | $28.18 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $14.13 / $22.39
| Facility | | $14.13 | $14.13 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $18.62 / $22.39
| Professional | | $14.13 | $18.62 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $24.55 / $28.18
| Facility | | $8.91 | $24.55 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.32 / $10.96 / $19.95
| Professional | | $8.32 | $10.96 | $19.95 |