- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $83.18 / $295.12
| Facility | | $25.12 | $83.18 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $58.88 / $158.49 / $398.11
| Facility | CO | $58.88 | $158.49 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $42.66 / $109.65 / $323.59
| Facility | CQ | $42.66 | $109.65 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $26.92 / $154.88
| Professional | | $19.05 | $26.92 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $70.79
| Professional | CO | $27.54 | $27.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $81.28
| Professional | CQ | $20.42 | $28.18 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $95.50 / $239.88
| Facility | | $38.90 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $28.18 / $75.86
| Professional | | $20.42 | $28.18 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $72.44 / $134.90
| Facility | | $52.48 | $72.44 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CO | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $44.67 / $44.67 / $44.67
| Facility | CQ | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $33.11 / $64.57
| Professional | | $21.38 | $33.11 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $45.71
| Facility | | $25.70 | $35.48 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $72.44
| Professional | | $25.12 | $34.67 | $72.44 |