- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $316.23 / $478.63
| Facility | | $257.04 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $144.54 / $588.84 / $831.76
| Professional | AA | $144.54 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $223.87 / $295.12 / $380.19
| Professional | QX | $223.87 | $295.12 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $275.42 / $346.74
| Professional | QY | $239.88 | $275.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $89.13 / $239.88 / $575.44
| Professional | QZ | $89.13 | $239.88 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $346.74 / $416.87
| Professional | | $309.03 | $346.74 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $229.09 / $4,466.84
| Facility | | $102.33 | $229.09 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $144.54 / $588.84 / $831.76
| Professional | AA | $144.54 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $72.44 / $281.84 / $380.19
| Professional | QX | $72.44 | $281.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $562.34
| Professional | QY | $234.42 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $85.11 / $218.78 / $575.44
| Professional | QZ | $85.11 | $218.78 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $354.81
| Facility | | $234.42 | $257.04 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,570.40 / $3,311.31 / $5,128.61
| Facility | | $2,570.40 | $3,311.31 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QX | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QY | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $537.03
| Professional | AA | $79.43 | $79.43 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $275.42
| Professional | QZ | $60.26 | $60.26 | $275.42 |