- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $52.48 / $109.65
| Facility | | $30.20 | $52.48 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $56.23 / $60.26 / $141.25
| Facility | CO | $56.23 | $60.26 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $33.11
| Facility | CQ | $28.18 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $26.92 / $56.23
| Professional | | $19.95 | $26.92 | $56.23 |
- 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
- 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
- $25.70 / $32.36 / $45.71
| Facility | | $25.70 | $32.36 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $38.02 / $45.71
| Professional | | $38.02 | $38.02 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $87.10
| Facility | | $54.95 | $64.57 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $33.11 / $61.66
| Professional | | $15.14 | $33.11 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $32.36 / $79.43
| Facility | | $19.95 | $32.36 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $61.66 / $128.82 / $128.82
| Facility | CO | $61.66 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $61.66 / $128.82 / $128.82
| Facility | CQ | $61.66 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $33.88 / $208.93
| Professional | | $26.30 | $33.88 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $32.36 / $46.77
| Facility | | $25.70 | $32.36 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $30.90 / $43.65
| Professional | | $22.39 | $30.90 | $43.65 |