- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $35.48 / $52.48
| Facility | | $19.05 | $35.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $24.55
| Professional | | $19.05 | $19.05 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $36.31 / $102.33
| Facility | | $19.95 | $36.31 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $37.15
| Professional | | $19.50 | $22.91 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Facility | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $41.69 / $64.57
| Facility | | $27.54 | $41.69 | $64.57 |
- 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
- $17.78 / $17.78 / $19.05
| Facility | | $17.78 | $17.78 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $28.18
| Professional | | $19.05 | $19.05 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $23.44 / $27.54
| Professional | | $19.05 | $23.44 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $33.11 / $45.71
| Professional | | $18.20 | $33.11 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $38.90
| Facility | | $19.50 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $19.05 / $20.42
| Professional | | $18.20 | $19.05 | $20.42 |