- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $245.47 / $537.03
| Facility | | $61.66 | $245.47 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $218.78
| Facility | CO | $169.82 | $169.82 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $89.13 / $91.20 / $302.00
| Facility | CQ | $89.13 | $91.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $34.67 / $91.20
| Professional | | $22.91 | $34.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $43.65 / $165.96
| Professional | CQ | $30.90 | $43.65 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $38.02 / $120.23
| Professional | | $23.99 | $38.02 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $66.07 / $426.58
| Facility | | $30.20 | $66.07 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $478.63
| Facility | CO | $169.82 | $169.82 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $89.13 / $165.96 / $616.60
| Facility | CQ | $89.13 | $165.96 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $89.13 / $151.36
| Professional | | $38.90 | $89.13 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $165.96
| Professional | CQ | $32.36 | $33.11 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $60.26 / $3,467.37
| Facility | | $43.65 | $60.26 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $74.13 / $141.25
| Professional | | $56.23 | $74.13 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $81.28
| Facility | | $28.84 | $38.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $50.12 / $89.13
| Professional | | $38.02 | $50.12 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $40.74 / $102.33
| Professional | | $29.51 | $40.74 | $102.33 |