- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $134.90 / $389.05
| Facility | | $23.44 | $134.90 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $186.21 / $309.03 / $436.52
| Facility | CO | $186.21 | $309.03 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $58.88 / $107.15 / $616.60
| Facility | CQ | $58.88 | $107.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $36.31 / $100.00
| Professional | | $17.38 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $64.57 / $104.71 / $104.71
| Professional | CO | $64.57 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $56.23 / $177.83
| Professional | CQ | $24.55 | $56.23 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $26.92
| Professional | | $19.95 | $19.95 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $20.42 / $21.88
| Professional | CQ | $19.05 | $20.42 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $43.65
| Facility | | $29.51 | $29.51 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $22.39 / $35.48
| Professional | | $17.78 | $22.39 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $40.74
| Facility | | $22.91 | $33.11 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $32.36 / $38.90
| Professional | | $26.92 | $32.36 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $47.86 / $75.86
| Facility | | $44.67 | $47.86 | $75.86 |
- 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
- $16.60 / $33.88 / $138.04
| Professional | | $16.60 | $33.88 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $32.36 / $33.11
| Professional | | $21.88 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $34.67
| Facility | | $33.11 | $33.11 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $42.66
| Professional | | $22.91 | $27.54 | $42.66 |