- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $223.87
| Facility | | $25.70 | $25.70 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $72.44 / $107.15
| Facility | CQ | $32.36 | $72.44 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $23.99 / $70.79
| Professional | | $15.85 | $23.99 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.78 / $104.71 / $134.90
| Professional | CO | $17.78 | $104.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $17.78 / $40.74 / $87.10
| Professional | CQ | $17.78 | $40.74 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Professional | CQ | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $63.10 / $85.11
| Facility | | $52.48 | $63.10 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $31.62
| Professional | | $18.62 | $26.30 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $79.43
| Facility | | $60.26 | $64.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $22.91 / $39.81
| Professional | | $13.18 | $22.91 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $31.62
| Facility | | $22.39 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $24.55 / $30.90
| Professional | | $18.62 | $24.55 | $30.90 |