- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $102.33 / $151.36
| Facility | | $40.74 | $102.33 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $81.28 / $93.33 / $123.03
| Facility | CQ | $81.28 | $93.33 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $22.91 / $74.13
| Professional | | $14.45 | $22.91 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.95 / $29.51 / $141.25
| Professional | CQ | $19.95 | $29.51 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $57.54 / $117.49
| Facility | | $26.92 | $57.54 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $66.07 / $85.11
| Professional | | $34.67 | $66.07 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $70.79
| Professional | CO | $63.10 | $63.10 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $169.82
| Facility | | $75.86 | $128.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $51.29
| Professional | | $25.12 | $31.62 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $134.90
| Facility | | $64.57 | $125.89 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $39.81
| Professional | | $25.12 | $25.12 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $77.62 / $134.90
| Facility | | $28.84 | $77.62 | $134.90 |
- 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
- $26.30 / $38.90 / $97.72
| Professional | | $26.30 | $38.90 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $33.11
| Facility | | $28.84 | $31.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $30.90 / $89.13
| Professional | | $24.55 | $30.90 | $89.13 |