- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $64.57 / $169.82
| Facility | | $30.90 | $64.57 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $29.51 / $64.57 / $154.88
| Facility | CQ | $29.51 | $64.57 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.20 / $77.62
| Professional | | $20.89 | $30.20 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Professional | CO | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $31.62 / $61.66
| Professional | CQ | $21.38 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | CQ | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $72.44
| Facility | | $37.15 | $47.86 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $36.31
| Professional | | $30.90 | $30.90 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $85.11
| Facility | | $54.95 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $54.95
| Professional | | $15.14 | $33.11 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $79.43
| Facility | | $20.42 | $33.11 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $63.10 / $128.82 / $128.82
| Facility | CQ | $63.10 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.88 / $218.78
| Professional | | $25.70 | $33.88 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $47.86
| Facility | | $26.30 | $32.36 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $43.65
| Professional | | $23.44 | $31.62 | $43.65 |