- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $95.50 / $251.19
| Facility | | $38.02 | $95.50 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $66.07 / $91.20 / $234.42
| Facility | CO | $66.07 | $91.20 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $77.62 / $109.65 / $288.40
| Facility | CQ | $77.62 | $109.65 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $37.15 / $131.83
| Professional | | $21.38 | $37.15 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $54.95 / $125.89 / $125.89
| Professional | CO | $54.95 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $60.26 / $117.49
| Professional | CQ | $30.90 | $60.26 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $32.36
| Professional | CQ | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $25.70 / $46.77
| Facility | | $24.55 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $26.92 / $43.65
| Professional | | $18.20 | $26.92 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $47.86
| Facility | | $33.11 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $38.90 / $45.71
| Professional | | $33.88 | $38.90 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $91.20 / $95.50
| Facility | | $64.57 | $91.20 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $36.31 / $63.10
| Professional | | $22.39 | $36.31 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $38.90 / $44.67
| Facility | | $28.18 | $38.90 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $57.54
| Professional | | $27.54 | $34.67 | $57.54 |