- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $57.54 / $398.11
| Facility | | $22.39 | $57.54 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $51.29 / $72.44 / $169.82
| Facility | CQ | $51.29 | $72.44 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $95.50
| Professional | | $19.95 | $32.36 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $158.49
| Professional | CO | $26.92 | $26.92 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.88 / $52.48 / $109.65
| Professional | CQ | $21.88 | $52.48 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $51.29
| Professional | CQ | $30.90 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $31.62 / $58.88
| Professional | | $27.54 | $31.62 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $64.57 / $95.50
| Facility | | $52.48 | $64.57 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CQ | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $30.20 / $54.95
| Professional | | $15.85 | $30.20 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $218.78 / $218.78
| Facility | | $38.02 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | CQ | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $218.78 / $269.15
| Professional | | $38.02 | $218.78 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $37.15 / $47.86
| Facility | | $37.15 | $37.15 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $37.15
| Professional | | $26.30 | $31.62 | $37.15 |