- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $100.00 / $323.59
| Facility | | $22.91 | $100.00 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.20 / $141.25 / $691.83
| Facility | CQ | $30.20 | $141.25 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $30.20 / $85.11
| Professional | | $19.05 | $30.20 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $26.92
| Professional | CO | $21.38 | $24.55 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $22.91 / $48.98 / $107.15
| Professional | CQ | $22.91 | $48.98 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $17.78 / $25.70 / $26.92
| Professional | CQ | $17.78 | $25.70 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.30 / $33.11
| Facility | | $23.44 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $35.48
| Professional | | $26.30 | $32.36 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $70.79
| Facility | | $44.67 | $54.95 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CQ | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $50.12
| Professional | | $20.89 | $25.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.88 / $18.62 / $27.54
| Facility | | $12.88 | $18.62 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.00 / $22.39 / $28.84
| Professional | | $10.00 | $22.39 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $32.36 / $37.15
| Facility | | $17.38 | $32.36 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.70 / $40.74
| Professional | | $20.89 | $25.70 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $33.88
| Professional | | $27.54 | $27.54 | $33.88 |