- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $169.82 / $323.59
| Facility | | $27.54 | $169.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $70.79 / $107.15 / $323.59
| Facility | CQ | $70.79 | $107.15 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $56.23 / $97.72
| Professional | | $16.98 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $72.44 / $72.44 / $72.44
| Professional | CO | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $18.20 / $52.48 / $72.44
| Professional | CQ | $18.20 | $52.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $33.11 / $43.65
| Facility | | $26.30 | $33.11 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.84 / $61.66
| Professional | | $26.30 | $28.84 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $100.00
| Facility | | $44.67 | $44.67 | $100.00 |
- 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
- $20.89 / $35.48 / $131.83
| Professional | | $20.89 | $35.48 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.95 / $72.44 / $134.90
| Facility | CQ | $19.95 | $72.44 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $22.39 / $31.62
| Facility | | $22.39 | $22.39 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $27.54 / $41.69
| Professional | | $19.50 | $27.54 | $41.69 |