- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $346.74 / $398.11
| Facility | | $269.15 | $346.74 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | QZ | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $128.82 / $588.84 / $977.24
| Professional | AA | $128.82 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $173.78 / $257.04 / $354.81
| Professional | QX | $173.78 | $257.04 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $57.54 / $190.55 / $398.11
| Professional | QY | $57.54 | $190.55 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $467.74 / $512.86 / $676.08
| Professional | QZ | $467.74 | $512.86 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $95.50 / $117.49 / $575.44
| Professional | AA | $95.50 | $117.49 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Professional | QX | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $114.82 / $141.25 / $501.19
| Professional | QZ | $114.82 | $141.25 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $57.54 / $112.20
| Facility | | $44.67 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $354.81 / $354.81 / $436.52
| Professional | AA | $354.81 | $354.81 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $2,884.03 / $3,388.44
| Facility | | $117.49 | $2,884.03 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6,025.60 / $6,025.60 / $7,079.46
| Facility | | $6,025.60 | $6,025.60 | $7,079.46 |