- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $34.67 / $141.25
| Facility | | $23.99 | $34.67 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $75.86 / $134.90 / $144.54
| Facility | CQ | $75.86 | $134.90 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.30 / $66.07
| Professional | | $15.85 | $26.30 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $134.90
| Professional | CO | $17.78 | $17.78 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $17.78 / $38.02 / $64.57
| Professional | CQ | $17.78 | $38.02 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | CQ | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $38.02
| Facility | | $28.18 | $28.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $36.31
| Professional | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Facility | | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $85.11
| Facility | | $60.26 | $75.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $28.18 / $43.65
| Professional | | $17.78 | $28.18 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $27.54 / $40.74
| Facility | | $25.12 | $27.54 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $25.70 / $36.31
| Professional | | $22.91 | $25.70 | $36.31 |