- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $79.43 / $281.84
| Facility | | $28.84 | $79.43 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $51.29 / $151.36 / $165.96
| Facility | CO | $51.29 | $151.36 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $45.71 / $141.25 / $660.69
| Facility | CQ | $45.71 | $141.25 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $43.65 / $120.23
| Professional | | $19.05 | $43.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $21.38
| Professional | CO | $18.62 | $18.62 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $20.42 / $61.66 / $204.17
| Professional | CQ | $20.42 | $61.66 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $70.79 / $75.86
| Professional | | $19.05 | $70.79 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $79.43
| Facility | | $54.95 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $20.89 / $42.66
| Professional | | $18.20 | $20.89 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $100.00
| Professional | | $27.54 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.20 / $30.90
| Professional | | $27.54 | $30.20 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Facility | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $61.66
| Professional | | $28.18 | $31.62 | $61.66 |