- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.30 / $67.61 / $323.59
| Facility | | $12.30 | $67.61 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $35.48 / $64.57 / $81.28
| Facility | CQ | $35.48 | $64.57 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.94 / $10.96 / $23.99
| Professional | | $7.94 | $10.96 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | CO | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $5.75 / $19.05 / $120.23
| Professional | CQ | $5.75 | $19.05 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.96 / $12.59 / $23.44
| Professional | | $10.96 | $12.59 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $95.50
| Facility | | $50.12 | $64.57 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Facility | CQ | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.17 / $12.88 / $21.38
| Professional | | $6.17 | $12.88 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $100.00 / $100.00
| Facility | | $19.50 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Facility | CQ | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $117.49 / $117.49
| Professional | | $16.22 | $117.49 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $16.22 / $20.89
| Facility | | $16.22 | $16.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.23 / $12.59 / $15.49
| Professional | | $10.23 | $12.59 | $15.49 |