- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $22.39 / $26.92 / $91.20
| Facility | | $22.39 | $26.92 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $93.33 / $93.33 / $93.33
| Facility | CO | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | CQ | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $15.14 / $25.12 / $40.74
| Professional | | $15.14 | $25.12 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Typical Low / Median / Typical High
- $28.18 / $28.18 / $83.18
| Professional | CQ | $28.18 | $28.18 | $83.18 |
- 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
- $74.13 / $125.89 / $204.17
| Facility | | $74.13 | $125.89 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $31.62 / $43.65
| Professional | | $25.12 | $31.62 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $64.57 / $89.13
| Facility | | $60.26 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.50 / $30.20 / $47.86
| Professional | | $19.50 | $30.20 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $20.42 / $32.36 / $83.18
| Facility | | $20.42 | $32.36 | $83.18 |
- 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 / $30.20 / $208.93
| Professional | | $26.30 | $30.20 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $25.70 / $46.77
| Facility | | $25.70 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.70 / $29.51 / $36.31
| Professional | | $25.70 | $29.51 | $36.31 |