- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $112.20 / $165.96
| Facility | | $50.12 | $112.20 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $28.18 / $169.82
| Professional | | $19.05 | $28.18 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $48.98 / $48.98 / $48.98
| Professional | CO | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $64.57 / $138.04
| Facility | | $30.20 | $64.57 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $74.13 / $93.33
| Professional | | $38.90 | $74.13 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $33.11 / $33.11
| Professional | CQ | $30.90 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $144.54 / $186.21
| Facility | | $85.11 | $144.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $35.48 / $52.48
| Professional | | $28.18 | $35.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $72.44 / $138.04 / $147.91
| Facility | | $72.44 | $138.04 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $44.67
| Professional | | $28.18 | $28.18 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $91.20 / $141.25
| Facility | | $36.31 | $91.20 | $141.25 |
- 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
- $31.62 / $63.10 / $95.50
| Professional | | $31.62 | $63.10 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $35.48 / $36.31
| Facility | | $32.36 | $35.48 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $100.00
| Professional | | $29.51 | $35.48 | $100.00 |