- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $58.88 / $323.59
| Facility | | $21.38 | $58.88 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $64.57 / $81.28 / $229.09
| Facility | CO | $64.57 | $81.28 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $31.62 / $125.89 / $309.03
| Facility | CQ | $31.62 | $125.89 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19.05 / $25.12 / $64.57
| Professional | | $19.05 | $25.12 | $64.57 |
- 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
- $17.78 / $54.95 / $54.95
| Professional | CQ | $17.78 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $33.11 / $57.54
| Professional | | $27.54 | $33.11 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $70.79 / $100.00
| Facility | | $52.48 | $70.79 | $100.00 |
- 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
- $16.22 / $29.51 / $56.23
| Professional | | $16.22 | $29.51 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $208.93 / $208.93
| Facility | | $44.67 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- CO
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | CO | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Typical Low / Median / Typical High
- $177.83 / $177.83 / $177.83
| Facility | CQ | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $269.15 / $269.15
| Professional | | $38.02 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $36.31 / $36.31 / $46.77
| Facility | | $36.31 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $31.62 / $35.48
| Professional | | $26.30 | $31.62 | $35.48 |