- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $208.93 / $1,819.70
| Facility | | $39.81 | $208.93 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $177.83 / $616.60 / $977.24
| Professional | AA | $177.83 | $616.60 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $81.28 / $309.03 / $562.34
| Professional | QX | $81.28 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $309.03 / $416.87
| Professional | QY | $239.88 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $125.89 / $537.03 / $891.25
| Professional | QZ | $125.89 | $537.03 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $144.54 / $478.63 / $912.01
| Professional | AA | $144.54 | $478.63 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $66.07 / $295.12 / $758.58
| Professional | QX | $66.07 | $295.12 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $85.11 / $251.19 / $645.65
| Professional | QY | $85.11 | $251.19 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $1,000.00
| Professional | QZ | $123.03 | $144.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QK | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QX | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QY | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $162.18
| Professional | QX | $85.11 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $134.90 / $134.90 / $134.90
| Professional | QY | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $89.13
| Professional | QZ | $79.43 | $85.11 | $89.13 |