- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $57.54 / $128.82 / $257.04
| Facility | | $57.54 | $128.82 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $501.19
| Facility | CO | $114.82 | $114.82 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $117.49 / $128.82 / $234.42
| Facility | CQ | $117.49 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $43.65 / $177.83
| Professional | | $22.39 | $43.65 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Professional | CO | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $67.61 / $147.91
| Professional | CQ | $30.90 | $67.61 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $194.98 / $239.88
| Facility | | $48.98 | $194.98 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $81.28 / $102.33
| Professional | | $41.69 | $81.28 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $95.50 / $162.18 / $213.80
| Facility | | $95.50 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $38.90 / $54.95
| Professional | | $30.90 | $38.90 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $77.62 / $151.36 / $162.18
| Facility | | $77.62 | $151.36 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $48.98
| Professional | | $30.20 | $30.20 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $95.50 / $144.54
| Facility | | $46.77 | $95.50 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $66.07 / $138.04 / $138.04
| Facility | CO | $66.07 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $66.07 / $138.04 / $138.04
| Facility | CQ | $66.07 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $74.13 / $107.15
| Professional | | $36.31 | $74.13 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $38.90 / $39.81
| Facility | | $34.67 | $38.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $40.74 / $109.65
| Professional | | $30.20 | $40.74 | $109.65 |