- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $97.72 / $275.42
| Facility | | $33.11 | $97.72 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $74.13 / $102.33 / $239.88
| Facility | CQ | $74.13 | $102.33 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $87.10
| Professional | | $19.95 | $32.36 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | CO | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.70 / $51.29 / $123.03
| Professional | CQ | $25.70 | $51.29 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $29.51 / $44.67
| Facility | | $24.55 | $29.51 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $42.66
| Professional | | $19.05 | $26.92 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $44.67
| Facility | | $30.90 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $36.31 / $42.66
| Professional | | $31.62 | $36.31 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $75.86 / $91.20
| Facility | | $33.88 | $75.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $54.95
| Professional | | $21.88 | $30.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $44.67
| Facility | | $22.91 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $54.95
| Professional | | $26.30 | $31.62 | $54.95 |