- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $125.89 / $363.08
| Facility | | $25.70 | $125.89 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $218.78
| Facility | CQ | $61.66 | $81.28 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $109.65
| Professional | | $19.05 | $29.51 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Professional | CO | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.70 / $61.66 / $213.80
| Professional | CQ | $25.70 | $61.66 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $30.90
| Professional | CQ | $24.55 | $25.70 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $50.12 / $66.07
| Facility | | $35.48 | $50.12 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $33.11 / $33.11
| Professional | | $31.62 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $37.15
| Facility | | $15.14 | $19.95 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $36.31
| Professional | | $31.62 | $31.62 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $64.57
| Facility | | $53.70 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $46.77 / $75.86
| Professional | | $24.55 | $46.77 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $117.49 / $323.59
| Facility | | $25.70 | $117.49 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $63.10 / $81.28 / $239.88
| Facility | CQ | $63.10 | $81.28 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $30.90 / $67.61
| Professional | | $20.42 | $30.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.84 / $69.18 / $147.91
| Professional | CQ | $28.84 | $69.18 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $75.86 / $75.86
| Professional | | $27.54 | $75.86 | $75.86 |
- 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
- $27.54 / $30.90 / $67.61
| Professional | | $27.54 | $30.90 | $67.61 |