- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $177.83 / $446.68
| Facility | | $28.18 | $177.83 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $50.12 / $123.03 / $239.88
| Facility | CO | $50.12 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $57.54 / $97.72 / $363.08
| Facility | CQ | $57.54 | $97.72 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $41.69 / $141.25
| Professional | | $19.05 | $41.69 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $288.40
| Professional | CO | $45.71 | $45.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $66.07 / $281.84
| Professional | CQ | $30.90 | $66.07 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | CO | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.95 / $22.91 / $27.54
| Professional | CQ | $19.95 | $22.91 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $45.71 / $58.88
| Facility | | $31.62 | $45.71 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $29.51 / $29.51
| Professional | | $27.54 | $29.51 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $19.95 / $33.11
| Facility | | $15.14 | $19.95 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $32.36
| Professional | | $28.18 | $28.18 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $53.70 / $64.57
| Facility | | $53.70 | $53.70 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $34.67 / $75.86
| Professional | | $23.44 | $34.67 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $162.18 / $407.38
| Facility | | $22.39 | $162.18 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $50.12 / $123.03 / $239.88
| Facility | CO | $50.12 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $398.11
| Facility | CQ | $56.23 | $97.72 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $29.51 / $83.18
| Professional | | $19.05 | $29.51 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $45.71 / $45.71 / $288.40
| Professional | CO | $45.71 | $45.71 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $36.31 / $67.61 / $281.84
| Professional | CQ | $36.31 | $67.61 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $75.86 / $75.86
| Professional | | $25.70 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $28.84 / $30.20
| Facility | | $24.55 | $28.84 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $70.79
| Professional | | $25.70 | $29.51 | $70.79 |