- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $251.19 / $457.09
| Facility | | $93.33 | $251.19 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $83.18 / $95.50 / $660.69
| Facility | CO | $83.18 | $95.50 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $69.18 / $114.82 / $446.68
| Facility | CQ | $69.18 | $114.82 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $61.66 / $117.49
| Professional | | $19.95 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $81.28
| Professional | CO | $51.29 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $120.23
| Professional | CQ | $32.36 | $54.95 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $45.71
| Facility | | $27.54 | $34.67 | $45.71 |
- 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 / $47.86 / $100.00
| Facility | | $47.86 | $47.86 | $100.00 |
- 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
- $22.39 / $38.02 / $138.04
| Professional | | $22.39 | $38.02 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $21.38 / $97.72 / $144.54
| Facility | CO | $21.38 | $97.72 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $23.99 / $87.10 / $123.03
| Facility | CQ | $23.99 | $87.10 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $28.84
| Professional | | $28.18 | $28.18 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Professional | CQ | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $23.44 / $33.11
| Facility | | $23.44 | $23.44 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $29.51 / $63.10
| Professional | | $21.38 | $29.51 | $63.10 |