- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $131.83 / $371.54
| Facility | | $79.43 | $131.83 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $371.54
| Facility | CO | $229.09 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $95.50 / $229.09 / $870.96
| Facility | CQ | $95.50 | $229.09 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $51.29 / $158.49
| Professional | | $19.05 | $51.29 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $138.04 / $147.91 / $162.18
| Professional | CO | $138.04 | $147.91 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $58.88 / $239.88
| Professional | CQ | $30.90 | $58.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $154.88 / $154.88
| Facility | | $40.74 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $67.61 / $85.11
| Professional | | $34.67 | $67.61 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $128.82 / $169.82
| Facility | | $75.86 | $128.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $48.98
| Professional | | $25.12 | $31.62 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $125.89 / $134.90
| Facility | | $64.57 | $125.89 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $25.12 / $39.81
| Professional | | $25.12 | $25.12 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $104.71 / $177.83
| Facility | | $48.98 | $104.71 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | CO | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $114.82 / $114.82
| Facility | CQ | $56.23 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $67.61 / $87.10
| Professional | | $30.90 | $67.61 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $33.11
| Facility | | $28.84 | $31.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $33.88 / $93.33
| Professional | | $26.92 | $33.88 | $93.33 |