- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $371.54
| Facility | | $302.00 | $346.74 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $389.05 / $776.25 / $1,096.48
| Professional | AA | $389.05 | $776.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $89.13 / $309.03 / $537.03
| Professional | QX | $89.13 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $245.47 / $309.03 / $616.60
| Professional | QY | $245.47 | $309.03 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $131.83 / $575.44 / $933.25
| Professional | QZ | $131.83 | $575.44 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $117.49 / $138.04 / $758.58
| Professional | AA | $117.49 | $138.04 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $58.88 / $83.18 / $158.49
| Professional | QX | $58.88 | $83.18 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $169.82 / $169.82 / $169.82
| Professional | QY | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $707.95
| Professional | QZ | $97.72 | $120.23 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QK | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QX | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QY | $52.48 | $52.48 | $52.48 |
- 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
- 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 / $89.13 / $275.42
| Professional | QZ | $85.11 | $89.13 | $275.42 |