- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $323.59 / $371.54
| Facility | | $30.20 | $323.59 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $316.23 / $588.84 / $1,023.29
| Professional | AA | $316.23 | $588.84 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $89.13 / $302.00 / $426.58
| Professional | QX | $89.13 | $302.00 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $245.47 / $295.12 / $407.38
| Professional | QY | $245.47 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $575.44 / $933.25
| Professional | QZ | $436.52 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $162.18 / $234.42 / $676.08
| Professional | AA | $162.18 | $234.42 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $81.28 / $158.49 / $389.05
| Professional | QX | $81.28 | $158.49 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $281.84
| Professional | QY | $154.88 | $154.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $123.03 / $147.91 / $912.01
| Professional | QZ | $123.03 | $147.91 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $407.38 / $660.69
| Professional | | $190.55 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QK | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QX | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QY | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $5,495.41 / $7,413.10
| Facility | | $3,235.94 | $5,495.41 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $95.50
| Professional | AA | $79.43 | $79.43 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $269.15
| Professional | QX | $70.79 | $85.11 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | QY | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $75.86 / $79.43 / $316.23
| Professional | QZ | $75.86 | $79.43 | $316.23 |