- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $123.03 / $416.87
| Facility | | $30.20 | $123.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $57.54 / $165.96 / $549.54
| Facility | CO | $57.54 | $165.96 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $524.81
| Facility | CQ | $58.88 | $128.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $44.67 / $134.90
| Professional | | $18.20 | $44.67 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 25
- Typical Low / Median / Typical High
- $19.50 / $19.50 / $19.50
| Professional | 25 | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $18.62 / $43.65 / $138.04
| Professional | CO | $18.62 | $43.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $58.88 / $162.18
| Professional | CQ | $24.55 | $58.88 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $95.50 / $239.88
| Facility | | $39.81 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $26.30 / $75.86
| Professional | | $18.62 | $26.30 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $70.79 / $120.23
| Facility | | $46.77 | $70.79 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CO | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $57.54
| Professional | | $19.05 | $29.51 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $42.66
| Facility | | $23.44 | $31.62 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $31.62 / $72.44
| Professional | | $23.44 | $31.62 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $93.33
| Professional | CQ | $77.62 | $77.62 | $93.33 |