- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $67.61 / $407.38
| Facility | | $30.20 | $67.61 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $57.54 / $102.33
| Facility | CQ | $21.38 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.22 / $30.90 / $181.97
| Professional | | $16.22 | $30.90 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Professional | CO | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.70 / $38.90 / $56.23
| Professional | CQ | $25.70 | $38.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $51.29 / $75.86
| Professional | | $24.55 | $51.29 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $60.26 / $70.79
| Facility | | $54.95 | $60.26 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $28.18 / $38.90
| Professional | | $19.95 | $28.18 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $30.90 / $52.48
| Professional | | $0.25 | $30.90 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $0.25 / $0.25 / $48.98
| Professional | | $0.25 | $0.25 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $32.36 / $35.48
| Professional | | $30.20 | $32.36 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $35.48
| Facility | | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $34.67 / $54.95
| Professional | | $25.70 | $34.67 | $54.95 |