- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $60.26 / $234.42
| Facility | | $22.39 | $60.26 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $67.61 / $117.49 / $204.17
| Facility | CQ | $67.61 | $117.49 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $79.43
| Professional | | $18.20 | $28.84 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Professional | CO | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $20.42 / $44.67 / $72.44
| Professional | CQ | $20.42 | $44.67 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $25.70 / $51.29
| Professional | CQ | $21.38 | $25.70 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $43.65
| Facility | | $29.51 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $37.15
| Professional | | $17.78 | $22.39 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $37.15 / $44.67
| Facility | | $25.70 | $37.15 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $36.31 / $43.65
| Professional | | $30.20 | $36.31 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $75.86
| Facility | | $44.67 | $52.48 | $75.86 |
- 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
- $19.05 / $36.31 / $154.88
| Professional | | $19.05 | $36.31 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $33.11
| Professional | | $22.39 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $37.15
| Facility | | $34.67 | $34.67 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.20 / $45.71
| Professional | | $24.55 | $30.20 | $45.71 |