- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $309.03 / $446.68
| Facility | | $44.67 | $309.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $169.82 / $630.96 / $1,096.48
| Professional | AA | $169.82 | $630.96 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $77.62 / $302.00 / $537.03
| Professional | QX | $77.62 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $181.97 / $302.00 / $478.63
| Professional | QY | $181.97 | $302.00 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $173.78 / $537.03 / $851.14
| Professional | QZ | $173.78 | $537.03 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $117.49 / $177.83 / $354.81
| Professional | AA | $117.49 | $177.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | QX | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Professional | QY | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $165.96
| Professional | QZ | $97.72 | $117.49 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $269.15 / $416.87
| Professional | | $151.36 | $269.15 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | QX | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | QZ | $79.43 | $79.43 | $85.11 |