- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $112.20 / $371.54
| Facility | | $30.90 | $112.20 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $67.61 / $162.18 / $407.38
| Facility | CO | $67.61 | $162.18 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $57.54 / $120.23 / $371.54
| Facility | CQ | $57.54 | $120.23 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $37.15 / $144.54
| Professional | | $20.89 | $37.15 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $151.36
| Professional | CO | $26.92 | $54.95 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $53.70 / $125.89
| Professional | CQ | $30.90 | $53.70 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $95.50 / $239.88
| Facility | | $37.15 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $28.84 / $75.86
| Professional | | $18.20 | $28.84 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $75.86 / $138.04
| Facility | | $54.95 | $75.86 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CO | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CQ | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $69.18
| Professional | | $22.91 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $45.71
| Facility | | $28.18 | $38.90 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $36.31 / $79.43
| Professional | | $26.92 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $63.10
| Professional | CO | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | CQ | $39.81 | $39.81 | $39.81 |