- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $100.00 / $346.74
| Facility | | $38.02 | $100.00 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $89.13 / $128.82 / $323.59
| Facility | CO | $89.13 | $128.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $50.12 / $125.89 / $478.63
| Facility | CQ | $50.12 | $125.89 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.88 / $104.71
| Professional | | $19.95 | $33.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $5.75 / $54.95 / $104.71
| Professional | CO | $5.75 | $54.95 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $51.29 / $117.49
| Professional | CQ | $30.90 | $51.29 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $20.89 / $26.92 / $27.54
| Professional | CO | $20.89 | $26.92 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $26.92
| Professional | CQ | $20.89 | $26.30 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $28.18 / $35.48
| Facility | | $25.12 | $28.18 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $38.90
| Professional | | $28.18 | $34.67 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $70.79
| Facility | | $44.67 | $54.95 | $70.79 |
- 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
- $22.39 / $26.92 / $51.29
| Professional | | $22.39 | $26.92 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $13.18 / $18.62 / $27.54
| Facility | | $13.18 | $18.62 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $23.99 / $27.54
| Professional | | $10.47 | $23.99 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $33.11
| Professional | | $20.42 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.38 / $34.67 / $39.81
| Facility | | $17.38 | $34.67 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $28.18 / $44.67
| Professional | | $21.38 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $37.15
| Professional | | $29.51 | $29.51 | $37.15 |