- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $131.83 / $151.36
| Facility | | $30.20 | $131.83 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $87.10
| Professional | | $19.05 | $26.92 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $295.12
| Professional | CQ | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $77.62 / $234.42
| Facility | | $30.90 | $77.62 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $77.62 / $97.72
| Professional | | $40.74 | $77.62 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $151.36 / $194.98
| Facility | | $89.13 | $151.36 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $37.15 / $54.95
| Professional | | $29.51 | $37.15 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $144.54 / $154.88
| Facility | | $74.13 | $144.54 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $46.77
| Professional | | $28.84 | $28.84 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $131.83
| Facility | | $30.20 | $52.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $70.79 / $141.25
| Professional | | $30.20 | $70.79 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $37.15 / $38.02
| Facility | | $33.88 | $37.15 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $102.33
| Professional | | $28.18 | $35.48 | $102.33 |