- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $125.89 / $186.21
| Facility | | $57.54 | $125.89 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $91.20 / $194.98 / $363.08
| Facility | CQ | $91.20 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $37.15 / $177.83
| Professional | | $19.95 | $37.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $50.12
| Professional | CO | $47.86 | $47.86 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.12 / $47.86 / $123.03
| Professional | CQ | $25.12 | $47.86 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $177.83 / $177.83
| Facility | | $45.71 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $93.33
| Professional | | $38.90 | $74.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $74.13
| Professional | CQ | $58.88 | $58.88 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $87.10 / $147.91 / $194.98
| Facility | | $87.10 | $147.91 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $56.23
| Professional | | $28.18 | $35.48 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $147.91
| Facility | | $72.44 | $138.04 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $44.67
| Professional | | $28.18 | $28.18 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $93.33 / $141.25
| Facility | | $39.81 | $93.33 | $141.25 |
- 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
- $33.88 / $72.44 / $97.72
| Professional | | $33.88 | $72.44 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $37.15
| Facility | | $32.36 | $36.31 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $37.15 / $100.00
| Professional | | $28.84 | $37.15 | $100.00 |