- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $173.78
| Facility | | $19.50 | $38.90 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $42.66 / $93.33 / $309.03
| Facility | CQ | $42.66 | $93.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $34.67 / $165.96
| Professional | | $16.98 | $34.67 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $85.11 / $134.90 / $154.88
| Professional | CO | $85.11 | $134.90 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.20 / $52.48 / $147.91
| Professional | CQ | $18.20 | $52.48 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $17.38 / $42.66
| Professional | | $13.18 | $17.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $30.20 / $45.71
| Professional | | $26.30 | $30.20 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $89.13
| Facility | | $50.12 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $52.48
| Professional | | $15.85 | $25.12 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $97.72
| Facility | | $18.20 | $30.90 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $53.70 / $107.15 / $107.15
| Facility | CQ | $53.70 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $26.92 / $169.82
| Professional | | $21.38 | $26.92 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $30.20 / $40.74
| Facility | | $26.92 | $30.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $24.55 / $44.67
| Professional | | $21.38 | $24.55 | $44.67 |