- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $33.11 / $75.86
| Facility | | $30.20 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $269.15
| Facility | CQ | $169.82 | $169.82 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $25.12 / $54.95
| Professional | | $15.85 | $25.12 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.02 / $51.29
| Facility | | $30.90 | $38.02 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $33.88 / $70.79
| Professional | | $30.90 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $100.00
| Facility | | $52.48 | $52.48 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CO | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CQ | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $41.69 / $154.88
| Professional | | $25.12 | $41.69 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $194.98
| Facility | CO | $22.91 | $22.91 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $144.54
| Facility | CQ | $123.03 | $123.03 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $36.31
| Facility | | $25.70 | $25.70 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $32.36 / $47.86
| Professional | | $22.91 | $32.36 | $47.86 |