- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $33.88 / $58.88
| Facility | | $13.80 | $33.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | CQ | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $12.88 / $48.98
| Professional | | $7.94 | $12.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $7.76 / $12.02 / $39.81
| Professional | CQ | $7.76 | $12.02 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $35.48 / $72.44
| Facility | | $10.00 | $35.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $12.02 / $25.12
| Professional | | $8.13 | $12.02 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $64.57
| Facility | | $54.95 | $57.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $12.88 / $23.44
| Professional | | $9.77 | $12.88 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $13.80 / $79.43
| Facility | | $8.51 | $13.80 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $54.95
| Facility | CQ | $26.92 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $13.18 / $89.13
| Professional | | $10.96 | $13.18 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.75 / $12.88 / $20.89
| Facility | | $11.75 | $12.88 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.72 / $12.88 / $20.42
| Professional | | $10.72 | $12.88 | $20.42 |