- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $645.65 / $1,479.11
| Facility | | $223.87 | $645.65 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $354.81 / $724.44 / $1,096.48
| Professional | AA | $354.81 | $724.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $177.83 / $302.00 / $537.03
| Professional | QX | $177.83 | $302.00 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $204.17 / $295.12 / $562.34
| Professional | QY | $204.17 | $295.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $147.91 / $575.44 / $891.25
| Professional | QZ | $147.91 | $575.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $29.51 / $117.49 / $173.78
| Professional | AA | $29.51 | $117.49 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $50.12 / $87.10 / $263.03
| Professional | QX | $50.12 | $87.10 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $104.71 / $131.83 / $186.21
| Professional | QZ | $104.71 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $281.84 / $309.03 / $407.38
| Professional | AA | $281.84 | $309.03 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $281.84 / $323.59 / $416.87
| Professional | QZ | $281.84 | $323.59 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $64.57 / $177.83
| Facility | | $39.81 | $64.57 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $218.78 / $1,445.44
| Facility | | $14.45 | $218.78 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $19.95 / $19.95 / $19.95
| Professional | QX | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $147.91
| Professional | QX | $100.00 | $100.00 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | AA | $79.43 | $79.43 | $79.43 |
- 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
- $128.82 / $128.82 / $134.90
| Professional | QY | $128.82 | $128.82 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $275.42
| Professional | QZ | $89.13 | $89.13 | $275.42 |