- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $158.49 / $436.52
| Facility | | $30.20 | $158.49 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $1,174.90
| Facility | CO | $95.50 | $331.13 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $70.79 / $104.71 / $239.88
| Facility | CQ | $70.79 | $104.71 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $100.00
| Professional | | $19.95 | $33.11 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $5.75 / $30.20 / $54.95
| Professional | CO | $5.75 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $29.51 / $39.81 / $104.71
| Professional | CQ | $29.51 | $39.81 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | CQ | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $23.99 / $43.65
| Professional | | $17.78 | $23.99 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $46.77 / $46.77
| Facility | | $22.91 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $26.92
| Professional | | $22.91 | $22.91 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $37.15 / $44.67
| Facility | | $31.62 | $37.15 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $36.31 / $75.86
| Professional | | $33.11 | $36.31 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $64.57 / $141.25
| Facility | | $56.23 | $64.57 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CO | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CQ | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $41.69 / $66.07
| Professional | | $26.92 | $41.69 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $51.29 / $87.10 / $144.54
| Facility | | $51.29 | $87.10 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CO | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $47.86
| Facility | CQ | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $33.11 / $58.88
| Professional | | $23.44 | $33.11 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $44.67
| Professional | CQ | $24.55 | $33.11 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $32.36 / $33.11
| Professional | | $19.05 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $36.31 / $53.70
| Professional | | $27.54 | $36.31 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $31.62 / $38.90
| Facility | | $28.18 | $31.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.88 / $47.86
| Professional | | $23.99 | $33.88 | $47.86 |