- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $138.04 / $436.52
| Facility | | $33.11 | $138.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $72.44 / $416.87 / $1,230.27
| Facility | CO | $72.44 | $416.87 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $44.67 / $218.78 / $812.83
| Facility | CQ | $44.67 | $218.78 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $37.15 / $117.49
| Professional | | $18.20 | $37.15 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $47.86 / $138.04
| Professional | CO | $42.66 | $47.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $61.66 / $204.17
| Professional | CQ | $24.55 | $61.66 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $15.85 / $15.85 / $15.85
| Professional | CO | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.50 / $20.42 / $53.70
| Professional | CQ | $19.50 | $20.42 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $23.44 / $29.51
| Facility | | $20.89 | $23.44 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $31.62
| Professional | | $23.44 | $29.51 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $70.79
| Facility | | $44.67 | $54.95 | $70.79 |
- 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
- $19.50 / $23.44 / $44.67
| Professional | | $19.50 | $23.44 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $11.22 / $16.22 / $26.30
| Facility | | $11.22 | $16.22 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $9.77 / $19.95 / $25.70
| Professional | | $9.77 | $19.95 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $33.11
| Professional | | $20.42 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $28.84 / $33.11
| Facility | | $17.38 | $28.84 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $22.91 / $38.90
| Professional | | $19.50 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $29.51
| Professional | | $24.55 | $24.55 | $29.51 |