- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $91.20 / $338.84
| Facility | | $38.90 | $91.20 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $208.93
| Facility | CO | $77.62 | $77.62 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $229.09
| Facility | CQ | $56.23 | $97.72 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $40.74 / $199.53
| Professional | | $19.95 | $40.74 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $87.10 / $151.36 / $151.36
| Professional | CO | $87.10 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $39.81 / $144.54
| Professional | CQ | $32.36 | $39.81 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $104.71 / $120.23
| Facility | | $75.86 | $104.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $41.69 / $97.72
| Professional | | $31.62 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $72.44 / $89.13
| Professional | | $53.70 | $72.44 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $100.00
| Facility | | $30.20 | $41.69 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $77.62 / $77.62 / $208.93
| Facility | CO | $77.62 | $77.62 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $97.72 / $144.54
| Facility | CQ | $56.23 | $97.72 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $60.26 / $87.10
| Professional | | $35.48 | $60.26 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $151.36
| Professional | CO | $87.10 | $87.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $32.36 / $54.95 / $165.96
| Professional | CQ | $32.36 | $54.95 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $70.79 / $75.86
| Facility | | $44.67 | $70.79 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $42.66 / $89.13
| Facility | | $28.18 | $42.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $70.79 / $91.20
| Professional | | $37.15 | $70.79 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $104.71 / $154.88
| Facility | | $54.95 | $104.71 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $56.23 / $107.15
| Professional | | $41.69 | $56.23 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $38.90 / $56.23
| Facility | | $38.90 | $38.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $40.74 / $91.20
| Professional | | $33.11 | $40.74 | $91.20 |