- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $46.77 / $114.82 / $323.59
| Facility | | $46.77 | $114.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Facility | CO | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $54.95 / $120.23 / $295.12
| Facility | CQ | $54.95 | $120.23 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $77.62
| Professional | | $19.05 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.92 / $54.95 / $457.09
| Professional | CO | $26.92 | $54.95 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $27.54 / $38.02 / $74.13
| Professional | CQ | $27.54 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $19.05 / $19.05 / $19.05
| Professional | CQ | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $24.55 / $64.57
| Professional | | $22.91 | $24.55 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Facility | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $81.28
| Professional | | $20.89 | $38.02 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $41.69 / $41.69
| Professional | | $41.69 | $41.69 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $41.69
| Professional | | $28.84 | $34.67 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $31.62 / $34.67
| Facility | | $31.62 | $31.62 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $37.15 / $67.61
| Professional | | $22.91 | $37.15 | $67.61 |