- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $46.77 / $112.20
| Facility | | $26.92 | $46.77 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.18 / $51.29 / $102.33
| Facility | CQ | $28.18 | $51.29 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $23.99 / $38.02
| Professional | | $16.98 | $23.99 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $16.22 / $21.38 / $25.12
| Professional | CQ | $16.22 | $21.38 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $43.65 / $61.66
| Facility | | $33.11 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $39.81
| Professional | | $33.88 | $33.88 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $85.11
| Facility | | $54.95 | $64.57 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $28.18 / $46.77
| Professional | | $13.18 | $28.18 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $28.84 / $79.43
| Facility | | $17.78 | $28.84 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | CQ | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $186.21
| Professional | | $21.88 | $28.18 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $42.66
| Facility | | $23.44 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $36.31
| Professional | | $19.95 | $26.92 | $36.31 |