- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $147.91 / $316.23
| Facility | | $25.70 | $147.91 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $162.18
| Facility | CO | $117.49 | $117.49 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $57.54 / $100.00 / $426.58
| Facility | CQ | $57.54 | $100.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $38.02 / $93.33
| Professional | | $19.05 | $38.02 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.78 / $42.66 / $56.23
| Professional | CO | $17.78 | $42.66 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $56.23 / $97.72
| Professional | CQ | $21.38 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | CQ | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $41.69
| Facility | | $30.20 | $30.20 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Facility | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $85.11
| Facility | | $60.26 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $47.86
| Professional | | $19.05 | $29.51 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $42.66
| Facility | | $26.30 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $39.81
| Professional | | $25.12 | $28.18 | $39.81 |