- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $100.00 / $316.23
| Facility | | $29.51 | $100.00 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $316.23
| Facility | CQ | $70.79 | $104.71 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $87.10
| Professional | | $19.95 | $30.90 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $20.89 / $40.74 / $52.48
| Professional | CO | $20.89 | $40.74 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $51.29 / $128.82
| Professional | CQ | $24.55 | $51.29 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $83.18 / $275.42
| Facility | | $44.67 | $83.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $33.88
| Professional | | $29.51 | $33.11 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $64.57 / $107.15
| Facility | | $44.67 | $64.57 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $38.02 / $61.66
| Professional | | $22.91 | $38.02 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $81.28
| Professional | | $30.90 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $40.74 / $42.66
| Professional | | $39.81 | $40.74 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $47.86
| Facility | | $32.36 | $36.31 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $64.57
| Professional | | $26.30 | $33.11 | $64.57 |