- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $22.91 / $54.95
| Facility | | $7.76 | $22.91 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.94 / $10.96
| Professional | | $3.02 | $7.94 | $10.96 |
- 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
- $5,011.87 / $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
- $12.59 / $13.18 / $13.18
| Professional | | $12.59 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.33 / $9.33 / $18.20
| Professional | | $9.33 | $9.33 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $12.59 / $12.59
| Facility | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $13.18 / $21.88
| Professional | | $8.13 | $13.18 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $20.89 / $33.88
| Facility | | $8.91 | $20.89 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $83.18
| Professional | | $75.86 | $75.86 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.59 / $13.80 / $27.54
| Facility | | $7.59 | $13.80 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $7.94 / $10.96
| Professional | | $3.02 | $7.94 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $11.22
| Facility | | $7.76 | $7.76 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.76 / $7.76 / $11.22
| Professional | | $7.76 | $7.76 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $0.10 / $0.10 / $0.10
| Facility | | $0.10 | $0.10 | $0.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $12.02 / $19.95
| Professional | | $8.13 | $12.02 | $19.95 |