- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $47.86 / $239.88
| Facility | | $23.99 | $47.86 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $147.91 / $316.23
| Facility | CQ | $39.81 | $147.91 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.90 / $295.12
| Professional | | $20.89 | $38.90 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $25.12
| Professional | CO | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $64.57 / $128.82
| Professional | CQ | $24.55 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.80 / $19.05 / $52.48
| Professional | | $13.80 | $19.05 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $35.48 / $53.70
| Professional | | $32.36 | $35.48 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $89.13
| Facility | | $50.12 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $63.10
| Professional | | $19.05 | $29.51 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $34.67 / $95.50
| Facility | | $21.88 | $34.67 | $95.50 |
- 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
- $24.55 / $32.36 / $218.78
| Professional | | $24.55 | $32.36 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $47.86
| Facility | | $32.36 | $36.31 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.90 / $54.95
| Professional | | $25.12 | $30.90 | $54.95 |