- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $77.62 / $316.23
| Facility | | $31.62 | $77.62 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $54.95 / $89.13 / $173.78
| Facility | CQ | $54.95 | $89.13 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $31.62 / $77.62
| Professional | | $19.05 | $31.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $21.38 / $21.88 / $24.55
| Professional | CO | $21.38 | $21.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $42.66 / $70.79
| Professional | CQ | $21.38 | $42.66 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $63.10 / $97.72
| Facility | | $34.67 | $63.10 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $36.31
| Professional | | $20.42 | $23.99 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $39.81
| Facility | | $34.67 | $34.67 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $70.79 / $75.86
| Facility | | $29.51 | $70.79 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $30.90 / $52.48
| Professional | | $16.60 | $30.90 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $32.36
| Facility | | $26.30 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.20 / $36.31
| Professional | | $22.39 | $30.20 | $36.31 |