- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $47.86 / $389.05
| Facility | | $47.86 | $47.86 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $134.90 / $549.54 / $1,071.52
| Professional | AA | $134.90 | $549.54 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $72.44 / $281.84 / $407.38
| Professional | QX | $72.44 | $281.84 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $616.60
| Professional | QY | $234.42 | $275.42 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $112.20 / $616.60 / $933.25
| Professional | QZ | $112.20 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $29.51 / $117.49 / $549.54
| Professional | AA | $29.51 | $117.49 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $12.88 / $87.10 / $323.59
| Professional | QX | $12.88 | $87.10 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $141.25 / $549.54
| Professional | QZ | $100.00 | $141.25 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $138.04 / $398.11
| Facility | | $54.95 | $138.04 | $398.11 |
- 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 / $85.11
| Professional | QX | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $275.42
| Professional | QZ | $85.11 | $85.11 | $275.42 |