- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $138.04 / $457.09
| Facility | | $24.55 | $138.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $61.66 / $114.82 / $398.11
| Facility | CO | $61.66 | $114.82 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $75.86 / $407.38 / $645.65
| Facility | CQ | $75.86 | $407.38 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $42.66 / $114.82
| Professional | | $19.05 | $42.66 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $104.71
| Professional | CO | $42.66 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $61.66 / $138.04
| Professional | CQ | $24.55 | $61.66 | $138.04 |
- 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 / $32.36 / $53.70
| Professional | CQ | $19.50 | $32.36 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $29.51 / $54.95
| Professional | | $21.88 | $29.51 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $38.90 / $47.86
| Facility | | $26.92 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $32.36 / $64.57
| Professional | | $28.18 | $32.36 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $70.79 / $79.43
| Facility | | $54.95 | $70.79 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $31.62 / $50.12
| Professional | | $15.85 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $32.36 / $50.12
| Professional | | $24.55 | $32.36 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $38.90 / $40.74
| Professional | | $35.48 | $38.90 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $42.66
| Facility | | $28.84 | $28.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $30.90 / $45.71
| Professional | | $22.91 | $30.90 | $45.71 |