- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $138.04 / $416.87
| Facility | | $75.86 | $138.04 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $95.50 / $100.00 / $154.88
| Facility | CQ | $95.50 | $100.00 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $47.86
| Professional | | $16.98 | $21.88 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $43.65 / $44.67
| Professional | CQ | $19.05 | $43.65 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $61.66 / $102.33
| Facility | | $48.98 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $27.54 / $69.18
| Professional | | $16.98 | $27.54 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $120.23 / $134.90
| Facility | | $60.26 | $120.23 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.88 / $72.44
| Professional | | $21.38 | $33.88 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $35.48 / $38.90
| Professional | | $24.55 | $35.48 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $302.00
| Facility | | $54.95 | $79.43 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $44.67 / $48.98
| Professional | | $15.85 | $44.67 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Facility | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $35.48 / $89.13
| Professional | | $23.44 | $35.48 | $89.13 |