- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $181.97 / $323.59
| Facility | | $31.62 | $181.97 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $75.86 / $169.82 / $398.11
| Facility | CQ | $75.86 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $51.29 / $89.13
| Professional | | $19.05 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Professional | CO | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $33.88 / $51.29 / $85.11
| Professional | CQ | $33.88 | $51.29 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $51.29
| Facility | | $30.90 | $38.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $72.44
| Professional | | $30.90 | $33.88 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $100.00
| Facility | | $52.48 | $52.48 | $100.00 |
- 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
- $25.12 / $41.69 / $154.88
| Professional | | $25.12 | $41.69 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $162.18
| Facility | CQ | $75.86 | $104.71 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $34.67
| Professional | CQ | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $37.15
| Facility | | $26.30 | $26.30 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $32.36 / $58.88
| Professional | | $23.44 | $32.36 | $58.88 |