- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $120.23 / $295.12
| Facility | | $23.44 | $120.23 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $67.61 / $112.20 / $380.19
| Facility | CO | $67.61 | $112.20 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $51.29 / $114.82 / $223.87
| Facility | CQ | $51.29 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $52.48 / $309.03
| Professional | | $22.91 | $52.48 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $29.51 / $117.49 / $151.36
| Professional | CO | $29.51 | $117.49 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $52.48 / $128.82
| Professional | CQ | $30.90 | $52.48 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $50.12 / $64.57
| Facility | | $43.65 | $50.12 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $57.54
| Professional | | $27.54 | $38.02 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $45.71 / $85.11
| Professional | | $30.90 | $45.71 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $48.98 / $162.18
| Facility | | $27.54 | $48.98 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | CO | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $138.04 / $138.04 / $138.04
| Facility | CQ | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $43.65 / $102.33
| Professional | | $27.54 | $43.65 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $53.70 / $102.33
| Professional | | $43.65 | $53.70 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $64.57
| Professional | | $38.90 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $45.71 / $70.79
| Professional | | $33.88 | $45.71 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $54.95
| Facility | | $38.90 | $38.90 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $85.11
| Professional | | $27.54 | $38.02 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $52.48
| Professional | | $44.67 | $44.67 | $52.48 |