- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $288.40
| Facility | | $30.90 | $69.18 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $56.23 / $102.33 / $169.82
| Facility | CO | $56.23 | $102.33 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $26.30 / $85.11 / $524.81
| Facility | CQ | $26.30 | $85.11 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $40.74 / $104.71
| Professional | | $21.88 | $40.74 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $5.75 / $30.20 / $69.18
| Professional | CO | $5.75 | $30.20 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.20 / $53.70 / $112.20
| Professional | CQ | $30.20 | $53.70 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $39.81 / $52.48
| Facility | | $36.31 | $39.81 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $26.92 / $44.67
| Professional | | $23.44 | $26.92 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $186.21
| Facility | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $30.20 / $48.98
| Professional | | $23.44 | $30.20 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $33.88 / $57.54
| Facility | | $25.12 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $57.54
| Professional | | $52.48 | $52.48 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $38.90 / $39.81
| Facility | | $15.14 | $38.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $52.48
| Professional | | $28.18 | $34.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Facility | | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | CO | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | CQ | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $295.12 / $295.12
| Professional | | $288.40 | $295.12 | $295.12 |