- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $117.49 / $331.13
| Facility | | $40.74 | $117.49 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $22.91 / $112.20 / $457.09
| Facility | CQ | $22.91 | $112.20 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $28.84 / $81.28
| Professional | | $15.85 | $28.84 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.78 / $17.78 / $85.11
| Professional | CO | $17.78 | $17.78 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $17.78 / $36.31 / $57.54
| Professional | CQ | $17.78 | $36.31 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $44.67
| Professional | | $16.98 | $16.98 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $16.98 / $16.98 / $44.67
| Professional | 52 | $16.98 | $16.98 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $30.90 / $61.66
| Professional | | $17.78 | $30.90 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $23.99 / $34.67
| Professional | | $20.42 | $23.99 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $27.54
| Facility | | $25.12 | $25.12 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $63.10
| Professional | | $18.20 | $30.90 | $63.10 |