- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $199.53
| Facility | | $30.20 | $30.20 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $177.83 / $831.76 / $1,445.44
| Professional | AA | $177.83 | $831.76 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $67.61 / $309.03 / $478.63
| Professional | QX | $67.61 | $309.03 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $257.04 / $309.03 / $416.87
| Professional | QY | $257.04 | $309.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $125.89 / $537.03 / $977.24
| Professional | QZ | $125.89 | $537.03 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $29.51 / $144.54 / $389.05
| Professional | AA | $29.51 | $144.54 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $229.09
| Professional | QX | $63.10 | $63.10 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $120.23 / $125.89 / $186.21
| Professional | QZ | $120.23 | $125.89 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $134.90 / $245.47 / $323.59
| Professional | AA | $134.90 | $245.47 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $39.81 / $83.18 / $154.88
| Professional | QX | $39.81 | $83.18 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $169.82 / $263.03
| Professional | QZ | $95.50 | $169.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,570.40 / $4,897.79
| Facility | | $2,041.74 | $2,570.40 | $4,897.79 |
- 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
- QZ
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | QZ | $275.42 | $275.42 | $275.42 |