- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $87.10 / $177.83
| Facility | | $30.90 | $87.10 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $61.66 / $64.57 / $257.04
| Facility | CQ | $61.66 | $64.57 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.70 / $213.80
| Professional | | $15.14 | $25.70 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Professional | CO | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.20 / $26.30 / $67.61
| Professional | CQ | $18.20 | $26.30 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $204.17 / $331.13
| Facility | | $57.54 | $204.17 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $31.62
| Professional | | $19.05 | $25.12 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $89.13
| Facility | | $64.57 | $75.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.20 / $45.71
| Professional | | $17.38 | $30.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $75.86
| Professional | | $32.36 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $27.54 / $67.61
| Facility | | $19.95 | $27.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $30.90 / $45.71
| Professional | | $17.38 | $30.90 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $34.67
| Facility | | $27.54 | $27.54 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $36.31
| Professional | | $24.55 | $28.84 | $36.31 |