- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $93.33 / $354.81 / $436.52
| Facility | | $93.33 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $128.82 / $724.44 / $1,096.48
| Professional | AA | $128.82 | $724.44 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $251.19 / $354.81 / $616.60
| Professional | QX | $251.19 | $354.81 | $616.60 |
- 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
- $85.11 / $218.78 / $851.14
| Professional | QZ | $85.11 | $218.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $446.68 / $645.65 / $741.31
| Professional | AA | $446.68 | $645.65 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $141.25
| Professional | QX | $107.15 | $107.15 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $107.15 / $107.15 / $107.15
| Professional | QY | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $102.33 / $123.03 / $416.87
| Professional | QZ | $102.33 | $123.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $371.54
| Facility | | $234.42 | $257.04 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $537.03
| Professional | AA | $75.86 | $75.86 | $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 / $85.11 / $85.11
| Professional | QZ | $85.11 | $85.11 | $85.11 |