- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $83.18 / $151.36
| Facility | | $19.05 | $83.18 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $43.65 / $69.18 / $186.21
| Facility | CQ | $43.65 | $69.18 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $21.88 / $48.98
| Professional | | $15.85 | $21.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $16.98 / $40.74 / $77.62
| Professional | CQ | $16.98 | $40.74 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $38.90
| Professional | CQ | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $50.12
| Professional | | $23.44 | $27.54 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $95.50
| Facility | | $50.12 | $64.57 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.70 / $46.77
| Professional | | $13.49 | $25.70 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $186.21 / $186.21
| Facility | | $40.74 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | CQ | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $239.88 / $239.88
| Professional | | $40.74 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $42.66
| Facility | | $33.11 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $30.90
| Professional | | $22.91 | $26.92 | $30.90 |