- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $70.79 / $269.15
| Facility | | $24.55 | $70.79 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $97.72 / $190.55 / $257.04
| Facility | CO | $97.72 | $190.55 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $64.57 / $162.18 / $436.52
| Facility | CQ | $64.57 | $162.18 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $50.12 / $144.54
| Professional | | $19.95 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $43.65 / $138.04
| Professional | CO | $42.66 | $43.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $64.57 / $177.83
| Professional | CQ | $24.55 | $64.57 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.88 / $28.18 / $37.15
| Professional | CQ | $21.88 | $28.18 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $42.66
| Facility | | $29.51 | $29.51 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $23.44 / $36.31
| Professional | | $19.50 | $23.44 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $42.66
| Professional | | $21.38 | $25.12 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $52.48
| Facility | | $20.42 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $46.77
| Professional | | $42.66 | $42.66 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $36.31
| Facility | | $15.14 | $33.11 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $30.20 / $47.86
| Professional | | $25.12 | $30.20 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | CO | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $158.49 / $158.49 / $158.49
| Facility | CQ | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $239.88 / $239.88
| Professional | | $186.21 | $239.88 | $239.88 |