- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $151.36 / $331.13
| Facility | | $32.36 | $151.36 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $64.57 / $85.11 / $269.15
| Facility | CO | $64.57 | $85.11 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $125.89 / $223.87 / $371.54
| Facility | CQ | $125.89 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $30.90 / $91.20
| Professional | | $20.89 | $30.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $5.75 / $5.75 / $30.20
| Professional | CO | $5.75 | $5.75 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $33.11 / $63.10 / $173.78
| Professional | CQ | $33.11 | $63.10 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $70.79 / $123.03
| Facility | | $27.54 | $70.79 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.18 / $43.65
| Professional | | $22.91 | $28.18 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.88 / $39.81 / $120.23
| Facility | | $21.88 | $39.81 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $28.84 / $38.90
| Professional | | $22.91 | $28.84 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $33.11 / $63.10
| Facility | | $22.91 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $22.91 / $22.91
| Professional | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $34.67 / $38.90
| Facility | | $34.67 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.88 / $39.81
| Professional | | $27.54 | $33.88 | $39.81 |