- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $102.33 / $602.56
| Facility | | $44.67 | $102.33 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | CO | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $66.07 / $89.13 / $691.83
| Facility | CQ | $66.07 | $89.13 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $32.36 / $83.18
| Professional | | $18.20 | $32.36 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $100.00
| Professional | CQ | $29.51 | $40.74 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $97.72
| Professional | | $22.39 | $33.11 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $57.54 / $436.52
| Facility | | $25.70 | $57.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | CO | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $66.07 / $416.87 / $912.01
| Facility | CQ | $66.07 | $416.87 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $74.13 / $117.49
| Professional | | $32.36 | $74.13 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $29.51 / $60.26 / $131.83
| Professional | CQ | $29.51 | $60.26 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $47.86 / $3,467.37
| Facility | | $37.15 | $47.86 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $58.88 / $117.49
| Professional | | $47.86 | $58.88 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $33.11 / $72.44
| Facility | | $22.39 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $39.81 / $79.43
| Professional | | $30.90 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $31.62 / $87.10
| Professional | | $24.55 | $31.62 | $87.10 |