- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $302.00
| Facility | | $41.69 | $50.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $128.82 / $676.08 / $1,071.52
| Professional | AA | $128.82 | $676.08 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $134.90 / $302.00 / $537.03
| Professional | QX | $134.90 | $302.00 | $537.03 |
- 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
- $112.20 / $416.87 / $831.76
| Professional | QZ | $112.20 | $416.87 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $93.33 / $389.05 / $588.84
| Professional | AA | $93.33 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $50.12 / $162.18 / $229.09
| Professional | QX | $50.12 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $60.26 / $63.10 / $245.47
| Professional | QY | $60.26 | $63.10 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $131.83 / $562.34
| Professional | QZ | $100.00 | $131.83 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,388.44 / $4,168.69
| Facility | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $128.82 / $128.82
| Facility | | $39.81 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QK | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QX | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QY | $30.90 | $30.90 | $30.90 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $2,570.40 / $5,370.32
| Facility | | $102.33 | $2,570.40 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $120.23 / $660.69 / $1,047.13
| Professional | AA | $120.23 | $660.69 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $72.44 / $302.00 / $588.84
| Professional | QX | $72.44 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $154.88 / $354.81 / $758.58
| Professional | QY | $154.88 | $354.81 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $93.33 / $363.08 / $776.25
| Professional | QZ | $93.33 | $363.08 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,370.32 / $5,623.41 / $5,623.41
| Facility | | $5,370.32 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,089.30 / $3,019.95 / $5,370.32
| Facility | | $2,089.30 | $3,019.95 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $363.08
| Professional | AA | $79.43 | $79.43 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $85.11
| Professional | QX | $70.79 | $70.79 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | QZ | $79.43 | $79.43 | $85.11 |