- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $112.20 / $316.23
| Facility | | $53.70 | $112.20 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $371.54
| Facility | CO | $218.78 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $97.72 / $97.72 / $114.82
| Facility | CQ | $97.72 | $97.72 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.84 / $83.18
| Professional | | $19.05 | $28.84 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $83.18
| Professional | CQ | $28.18 | $28.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $36.31 / $107.15
| Professional | | $24.55 | $36.31 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $40.74 / $245.47
| Facility | | $26.30 | $40.74 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $218.78 / $218.78 / $371.54
| Facility | CO | $218.78 | $218.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $114.82 / $114.82 / $114.82
| Facility | CQ | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $81.28 / $138.04
| Professional | | $36.31 | $81.28 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $83.18
| Professional | CQ | $28.18 | $28.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $53.70 / $3,467.37
| Facility | | $40.74 | $53.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $53.70 / $64.57 / $128.82
| Professional | | $53.70 | $64.57 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $35.48 / $75.86
| Facility | | $25.70 | $35.48 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $33.88 / $44.67 / $79.43
| Professional | | $33.88 | $44.67 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $34.67 / $89.13
| Professional | | $27.54 | $34.67 | $89.13 |