- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $223.87 / $371.54
| Facility | | $52.48 | $223.87 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $181.97 / $181.97 / $181.97
| Facility | CO | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $47.86 / $275.42 / $512.86
| Facility | CQ | $47.86 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $22.91 / $58.88
| Professional | | $15.14 | $22.91 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $43.65
| Professional | CO | $42.66 | $42.66 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $56.23 / $100.00
| Professional | CQ | $19.05 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $56.23
| Professional | | $25.70 | $32.36 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $15.14 / $15.14
| Facility | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $34.67 / $67.61
| Professional | | $15.14 | $34.67 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $338.84 / $371.54
| Facility | | $338.84 | $338.84 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.88 / $52.48
| Professional | | $22.91 | $33.88 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $41.69 / $60.26
| Professional | | $30.90 | $41.69 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $34.67 / $45.71
| Facility | | $32.36 | $34.67 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $32.36 / $51.29
| Professional | | $15.49 | $32.36 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $41.69 / $72.44
| Professional | | $26.30 | $41.69 | $72.44 |