- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $23.44 / $37.15 / $97.72
| Facility | | $23.44 | $37.15 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $56.23 / $309.03 / $309.03
| Facility | CO | $56.23 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $48.98 / $54.95 / $309.03
| Facility | CQ | $48.98 | $54.95 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $281.84
| Professional | | $19.50 | $30.20 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- CO
- Typical Low / Median / Typical High
- $26.30 / $26.30 / $26.30
| Professional | CO | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $25.70
| Professional | CQ | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $14.13 / $19.95 / $51.29
| Professional | | $14.13 | $19.95 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $34.67 / $52.48
| Professional | | $31.62 | $34.67 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50.12 / $67.61 / $91.20
| Facility | | $50.12 | $67.61 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $29.51 / $60.26
| Professional | | $19.50 | $29.51 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $33.88 / $102.33
| Facility | | $20.89 | $33.88 | $102.33 |
- 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
- $25.70 / $32.36 / $208.93
| Professional | | $25.70 | $32.36 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $35.48 / $46.77
| Facility | | $32.36 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $46.77
| Professional | | $25.70 | $29.51 | $46.77 |