- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $37.15 / $190.55 / $245.47
| Facility | | $37.15 | $190.55 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $173.78 / $331.13 / $354.81
| Facility | CO | $173.78 | $331.13 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $77.62 / $97.72 / $239.88
| Facility | CQ | $77.62 | $97.72 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $37.15 / $91.20
| Professional | | $19.95 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $125.89 / $125.89 / $125.89
| Professional | CO | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $29.51 / $54.95 / $79.43
| Professional | CQ | $29.51 | $54.95 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $41.69 / $54.95
| Facility | | $33.11 | $41.69 | $54.95 |
- 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 / $56.23 / $100.00
| Facility | | $56.23 | $56.23 | $100.00 |
- 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
- $26.30 / $44.67 / $165.96
| Professional | | $26.30 | $44.67 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $112.20 / $112.20 / $123.03
| Facility | CO | $112.20 | $112.20 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $83.18 / $112.20 / $158.49
| Facility | CQ | $83.18 | $112.20 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $39.81
| Facility | | $28.18 | $28.18 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $33.11 / $58.88
| Professional | | $24.55 | $33.11 | $58.88 |