- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $120.23 / $407.38
| Facility | | $31.62 | $120.23 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $67.61 / $173.78 / $288.40
| Facility | CO | $67.61 | $173.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $38.02 / $85.11 / $208.93
| Facility | CQ | $38.02 | $85.11 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $32.36 / $112.20
| Professional | | $20.89 | $32.36 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $104.71
| Professional | CO | $26.92 | $26.92 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $27.54 / $56.23 / $147.91
| Professional | CQ | $27.54 | $56.23 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | CQ | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $33.11 / $63.10
| Professional | | $29.51 | $33.11 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $95.50
| Facility | | $54.95 | $64.57 | $95.50 |
- 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
- $16.60 / $32.36 / $61.66
| Professional | | $16.60 | $32.36 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $234.42 / $234.42
| Facility | | $40.74 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | CO | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $199.53
| Facility | CQ | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $295.12 / $295.12
| Professional | | $40.74 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $51.29
| Facility | | $39.81 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $34.67 / $40.74
| Professional | | $28.18 | $34.67 | $40.74 |