- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $85.11 / $288.40
| Facility | | $20.89 | $85.11 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $93.33 / $199.53 / $380.19
| Facility | CO | $93.33 | $199.53 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $33.11 / $89.13 / $181.97
| Facility | CQ | $33.11 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.62 / $25.12 / $58.88
| Professional | | $18.62 | $25.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $66.07
| Professional | CO | $27.54 | $27.54 | $66.07 |
- 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
- Professional
- Modifier
- Typical Low / Median / Typical High
- $24.55 / $24.55 / $24.55
| Professional | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.91 / $26.30 / $33.11
| Facility | | $22.91 | $26.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $32.36 / $34.67
| Professional | | $26.30 | $32.36 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $52.48 / $70.79
| Facility | | $44.67 | $52.48 | $70.79 |
- 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
- $20.89 / $25.12 / $50.12
| Professional | | $20.89 | $25.12 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $12.59 / $18.20 / $27.54
| Facility | | $12.59 | $18.20 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $10.47 / $22.39 / $27.54
| Professional | | $10.47 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $17.78 / $32.36 / $36.31
| Facility | | $17.78 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $25.12 / $40.74
| Professional | | $21.38 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $27.54 / $33.11
| Professional | | $27.54 | $27.54 | $33.11 |