- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $100.00 / $602.56
| Facility | | $41.69 | $100.00 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $100.00
| Facility | CO | $60.26 | $60.26 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $46.77 / $87.10 / $724.44
| Facility | CQ | $46.77 | $87.10 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $61.66 / $239.88
| Professional | | $21.88 | $61.66 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $18.20 / $18.20 / $18.20
| Professional | CO | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $58.88 / $234.42
| Professional | CQ | $19.05 | $58.88 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $229.09 / $407.38
| Facility | | $70.79 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $43.65 / $60.26
| Professional | | $25.70 | $43.65 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $89.13
| Facility | | $33.88 | $38.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $38.90 / $67.61
| Professional | | $25.12 | $38.90 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $95.50 / $151.36
| Facility | | $43.65 | $95.50 | $151.36 |
- 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 / $41.69 / $58.88
| Professional | | $22.39 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $50.12 / $63.10
| Professional | | $37.15 | $50.12 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $44.67 / $67.61
| Professional | | $38.02 | $44.67 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.30 / $33.11
| Facility | | $23.44 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $29.51 / $83.18
| Professional | | $23.44 | $29.51 | $83.18 |