- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $131.83 / $363.08
| Facility | | $60.26 | $131.83 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $371.54
| Facility | CO | $229.09 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $97.72 / $204.17 / $371.54
| Facility | CQ | $97.72 | $204.17 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $53.70 / $120.23
| Professional | | $19.05 | $53.70 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $18.62 / $18.62 / $21.38
| Professional | CO | $18.62 | $18.62 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $112.20
| Professional | CQ | $37.15 | $50.12 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $64.57 / $75.86
| Professional | | $51.29 | $64.57 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $40.74
| Professional | | $25.12 | $31.62 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $83.18 / $134.90
| Facility | | $31.62 | $83.18 | $134.90 |
- 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
- $28.84 / $37.15 / $66.07
| Professional | | $28.84 | $37.15 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $33.11
| Facility | | $31.62 | $31.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $28.18 / $70.79
| Professional | | $26.30 | $28.18 | $70.79 |