- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $77.62 / $398.11
| Facility | | $33.88 | $77.62 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $51.29 / $51.29 / $51.29
| Facility | CO | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $39.81 / $158.49 / $416.87
| Facility | CQ | $39.81 | $158.49 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $35.48 / $120.23
| Professional | | $21.88 | $35.48 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $104.71
| Professional | CO | $54.95 | $54.95 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $31.62 / $51.29 / $117.49
| Professional | CQ | $31.62 | $51.29 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $70.79
| Facility | | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $70.79 / $75.86
| Professional | | $20.42 | $70.79 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $67.61 / $79.43
| Facility | | $54.95 | $67.61 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $48.98
| Professional | | $19.95 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $56.23 / $95.50
| Professional | | $33.88 | $56.23 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $36.31 / $38.90
| Professional | | $32.36 | $36.31 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $35.48 / $39.81
| Facility | | $35.48 | $35.48 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $40.74 / $69.18
| Professional | | $31.62 | $40.74 | $69.18 |