- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $128.82 / $223.87
| Facility | | $58.88 | $128.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | CO | $114.82 | $114.82 | $114.82 |
- 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
- $20.89 / $39.81 / $107.15
| Professional | | $20.89 | $39.81 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $33.88 / $69.18 / $165.96
| Professional | CQ | $33.88 | $69.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $77.62 / $91.20
| Professional | | $61.66 | $77.62 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $38.02 / $39.81
| Professional | | $30.20 | $38.02 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $66.07 / $162.18
| Facility | | $38.02 | $66.07 | $162.18 |
- 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
- $33.88 / $41.69 / $58.88
| Professional | | $33.88 | $41.69 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $39.81
| Facility | | $38.90 | $38.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $34.67 / $81.28
| Professional | | $29.51 | $34.67 | $81.28 |