- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $120.23 / $331.13
| Facility | | $74.13 | $120.23 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $165.96
| Facility | CO | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $263.03 / $263.03 / $263.03
| Facility | CQ | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.70 / $67.61
| Professional | | $19.05 | $25.70 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $27.54
| Professional | CO | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $20.42 / $20.42 / $26.92
| Professional | CQ | $20.42 | $20.42 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $79.43 / $131.83
| Facility | | $63.10 | $79.43 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $33.11 / $75.86
| Professional | | $19.95 | $33.11 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $134.90 / $162.18
| Facility | | $74.13 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $35.48 / $72.44
| Professional | | $18.20 | $35.48 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $44.67 / $47.86
| Professional | | $27.54 | $44.67 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $89.13 / $181.97
| Facility | | $50.12 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.85 / $60.26 / $102.33
| Professional | | $15.85 | $60.26 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $26.92 / $26.92
| Facility | | $26.92 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.92 / $40.74 / $89.13
| Professional | | $26.92 | $40.74 | $89.13 |