- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $131.83 / $380.19
| Facility | | $47.86 | $131.83 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $316.23
| Facility | CO | $302.00 | $302.00 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $81.28 / $95.50 / $436.52
| Facility | CQ | $81.28 | $95.50 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $50.12 / $162.18
| Professional | | $19.05 | $50.12 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $47.86 / $104.71
| Professional | CO | $42.66 | $47.86 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $57.54 / $151.36
| Professional | CQ | $21.38 | $57.54 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | CQ | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $69.18 / $144.54
| Facility | | $19.95 | $69.18 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $30.90 / $66.07
| Professional | | $19.95 | $30.90 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $57.54 / $64.57
| Facility | | $54.95 | $57.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $52.48
| Professional | | $20.89 | $30.90 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $134.90
| Facility | | $18.62 | $28.18 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | CO | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | CQ | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.84 / $85.11
| Professional | | $20.42 | $28.84 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $42.66
| Facility | | $25.12 | $30.20 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $30.20 / $48.98
| Professional | | $25.70 | $30.20 | $48.98 |