- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $128.82 / $323.59
| Facility | | $33.88 | $128.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $75.86 / $177.83 / $407.38
| Facility | CO | $75.86 | $177.83 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $218.78
| Facility | CQ | $56.23 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $33.11 / $114.82
| Professional | | $20.89 | $33.11 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $42.66 / $173.78
| Professional | CQ | $30.90 | $42.66 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $16.60 / $21.88 / $31.62
| Professional | | $16.60 | $21.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $85.11
| Professional | | $26.30 | $32.36 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $72.44 / $204.17
| Facility | | $56.23 | $72.44 | $204.17 |
- 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
- $25.12 / $32.36 / $63.10
| Professional | | $25.12 | $32.36 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $30.90 / $37.15 / $45.71
| Professional | | $30.90 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $40.74 / $40.74
| Professional | | $32.36 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.99 / $33.11 / $57.54
| Facility | | $23.99 | $33.11 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Professional | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $173.78
| Facility | | $21.38 | $39.81 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $39.81 / $173.78
| Professional | | $21.38 | $39.81 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $38.90 / $39.81
| Facility | | $33.11 | $38.90 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $48.98
| Professional | | $24.55 | $36.31 | $48.98 |