- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $389.05 / $489.78
| Facility | | $67.61 | $389.05 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $40.74 / $40.74 / $489.78
| Facility | CQ | $40.74 | $40.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $77.62
| Professional | | $15.85 | $26.92 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.20 / $43.65 / $107.15
| Professional | CQ | $18.20 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $30.20 / $91.20
| Professional | | $20.42 | $30.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $40.74 / $446.68
| Facility | | $21.38 | $40.74 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $40.74 / $346.74 / $676.08
| Facility | CQ | $40.74 | $346.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $69.18 / $107.15
| Professional | | $27.54 | $69.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.20 / $53.70 / $173.78
| Professional | CQ | $18.20 | $53.70 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $44.67 / $3,467.37
| Facility | | $35.48 | $44.67 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $54.95 / $102.33
| Professional | | $43.65 | $54.95 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $31.62 / $66.07
| Facility | | $20.42 | $31.62 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $79.43
| Professional | | $27.54 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $85.11
| Professional | | $23.44 | $28.84 | $85.11 |