- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $144.54 / $524.81
| Facility | | $37.15 | $144.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $70.79 / $275.42 / $416.87
| Facility | CO | $70.79 | $275.42 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $58.88 / $95.50 / $512.86
| Facility | CQ | $58.88 | $95.50 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $38.02 / $128.82
| Professional | | $18.20 | $38.02 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $42.66 / $42.66 / $43.65
| Professional | CO | $42.66 | $42.66 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $21.38 / $70.79 / $269.15
| Professional | CQ | $21.38 | $70.79 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $31.62
| Professional | | $16.60 | $21.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $26.92 / $79.43
| Professional | | $21.88 | $26.92 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $72.44 / $204.17
| Facility | | $47.86 | $72.44 | $204.17 |
- 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
- $21.88 / $27.54 / $53.70
| Professional | | $21.88 | $27.54 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $31.62 / $38.02
| Professional | | $25.70 | $31.62 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $39.81
| Professional | | $32.36 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $51.29
| Facility | | $19.05 | $28.84 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $31.62
| Professional | | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $131.83
| Facility | | $21.38 | $35.48 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $35.48 / $131.83
| Professional | | $21.38 | $35.48 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $31.62 / $33.11
| Facility | | $28.84 | $31.62 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $30.90 / $38.90
| Professional | | $21.88 | $30.90 | $38.90 |