- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $63.10 / $288.40
| Facility | | $22.39 | $63.10 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $89.13 / $309.03 / $630.96
| Facility | CO | $89.13 | $309.03 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $57.54 / $134.90 / $630.96
| Facility | CQ | $57.54 | $134.90 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $51.29 / $229.09
| Professional | | $19.05 | $51.29 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $45.71 / $104.71 / $173.78
| Professional | CO | $45.71 | $104.71 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $34.67 / $66.07 / $234.42
| Professional | CQ | $34.67 | $66.07 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $13.49 / $18.62 / $46.77
| Professional | | $13.49 | $18.62 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $47.86
| Professional | | $28.84 | $31.62 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $89.13
| Facility | | $50.12 | $67.61 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $26.92 / $56.23
| Professional | | $17.38 | $26.92 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $37.15 / $114.82
| Facility | | $20.42 | $37.15 | $114.82 |
- 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
- $22.39 / $29.51 / $186.21
| Professional | | $22.39 | $29.51 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $42.66
| Facility | | $28.84 | $31.62 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $50.12
| Professional | | $23.44 | $26.92 | $50.12 |