- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $97.72 / $380.19
| Facility | | $17.78 | $97.72 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $33.11 / $100.00 / $218.78
| Facility | CQ | $33.11 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $26.92 / $100.00
| Professional | | $15.85 | $26.92 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $17.78 / $104.71 / $446.68
| Professional | CO | $17.78 | $104.71 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $17.78 / $51.29 / $208.93
| Professional | CQ | $17.78 | $51.29 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $6.46 / $6.46 / $6.46
| Professional | 52 | $6.46 | $6.46 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $35.48
| Professional | CQ | $18.62 | $26.30 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $48.98
| Professional | | $22.91 | $28.18 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $64.57 / $95.50
| Facility | | $50.12 | $64.57 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $38.02
| Facility | CQ | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $25.12 / $47.86
| Professional | | $13.49 | $25.12 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $169.82 / $169.82
| Facility | | $32.36 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Facility | CQ | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $229.09 / $229.09
| Professional | | $32.36 | $229.09 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $40.74
| Facility | | $31.62 | $31.62 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $32.36
| Professional | | $22.39 | $26.92 | $32.36 |