- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $125.89 / $371.54
| Facility | | $53.70 | $125.89 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $112.20
| Facility | CO | $85.11 | $85.11 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $60.26 / $83.18 / $100.00
| Facility | CQ | $60.26 | $83.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $67.61 / $398.11
| Professional | | $25.12 | $67.61 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Professional | CO | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $69.18 / $213.80
| Professional | CQ | $30.90 | $69.18 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $257.04 / $588.84
| Facility | | $102.33 | $257.04 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $74.13
| Professional | | $32.36 | $54.95 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $47.86 / $109.65
| Facility | | $43.65 | $47.86 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $47.86 / $79.43
| Professional | | $30.20 | $47.86 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $93.33 / $162.18
| Facility | | $38.02 | $93.33 | $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
- $30.20 / $57.54 / $77.62
| Professional | | $30.20 | $57.54 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $54.95 / $79.43
| Professional | | $44.67 | $54.95 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $50.12 / $81.28
| Professional | | $47.86 | $50.12 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $39.81
| Facility | | $28.18 | $31.62 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.02 / $89.13
| Professional | | $28.84 | $38.02 | $89.13 |