- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $72.44 / $263.03
| Facility | | $24.55 | $72.44 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $204.17 / $269.15 / $269.15
| Facility | CO | $204.17 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $72.44 / $102.33 / $204.17
| Facility | CQ | $72.44 | $102.33 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $30.20 / $81.28
| Professional | | $18.62 | $30.20 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $44.67 / $457.09 / $457.09
| Professional | CO | $44.67 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.84 / $48.98 / $97.72
| Professional | CQ | $28.84 | $48.98 | $97.72 |
- 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
- CO
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $27.54
| Professional | CO | $26.92 | $26.92 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $22.91 / $26.92 / $60.26
| Professional | CQ | $22.91 | $26.92 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $37.15
| Facility | | $24.55 | $24.55 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.49 / $20.89 / $40.74
| Professional | | $15.49 | $20.89 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $38.90 / $47.86
| Facility | | $27.54 | $38.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $38.90 / $46.77
| Professional | | $32.36 | $38.90 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $56.23 / $79.43
| Facility | | $50.12 | $56.23 | $79.43 |
- 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
- $20.42 / $37.15 / $165.96
| Professional | | $20.42 | $37.15 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $32.36 / $33.11
| Professional | | $22.39 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $39.81
| Facility | | $34.67 | $34.67 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $33.11 / $46.77
| Professional | | $25.70 | $33.11 | $46.77 |