- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $229.09 / $501.19
| Facility | | $37.15 | $229.09 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $70.79 / $134.90 / $309.03
| Facility | CO | $70.79 | $134.90 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $61.66 / $81.28 / $575.44
| Facility | CQ | $61.66 | $81.28 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $47.86 / $109.65
| Professional | | $19.05 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $85.11
| Professional | CO | $47.86 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $23.99 / $61.66 / $91.20
| Professional | CQ | $23.99 | $61.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.88 / $21.88 / $21.88
| Professional | CQ | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $75.86 / $123.03
| Facility | | $33.88 | $75.86 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $27.54 / $35.48
| Professional | | $22.91 | $27.54 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $39.81 / $120.23
| Facility | | $20.89 | $39.81 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $25.12 / $33.11
| Professional | | $20.89 | $25.12 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $28.18 / $53.70
| Facility | | $18.62 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $28.84 / $31.62
| Facility | | $28.84 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $27.54 / $34.67
| Professional | | $23.99 | $27.54 | $34.67 |