- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $123.03 / $371.54
| Facility | | $36.31 | $123.03 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $61.66 / $93.33 / $478.63
| Facility | CO | $61.66 | $93.33 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $61.66 / $154.88 / $512.86
| Facility | CQ | $61.66 | $154.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $44.67 / $125.89
| Professional | | $17.38 | $44.67 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $18.62 / $47.86 / $93.33
| Professional | CO | $18.62 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $22.39 / $60.26 / $234.42
| Professional | CQ | $22.39 | $60.26 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $22.91 / $27.54
| Professional | CQ | $19.05 | $22.91 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.98 / $22.91 / $40.74
| Professional | | $16.98 | $22.91 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $38.90 / $38.90
| Facility | | $19.50 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $28.18 / $56.23
| Professional | | $22.39 | $28.18 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $31.62 / $37.15
| Facility | | $26.92 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $30.90 / $64.57
| Professional | | $27.54 | $30.90 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $64.57 / $141.25
| Facility | | $47.86 | $64.57 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CO | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $56.23
| Professional | | $22.91 | $35.48 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $83.18 / $134.90
| Facility | | $47.86 | $83.18 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CO | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $52.48
| Professional | | $18.62 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $35.48
| Professional | CO | $19.95 | $19.95 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $16.98 / $21.88 / $31.62
| Professional | CQ | $16.98 | $21.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $33.11
| Professional | | $17.78 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Facility | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $44.67
| Professional | | $25.70 | $31.62 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $28.84 / $31.62
| Facility | | $23.44 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $26.92 / $41.69
| Professional | | $20.42 | $26.92 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $77.62
| Professional | CQ | $77.62 | $77.62 | $77.62 |