- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $275.42 / $389.05 / $446.68
| Facility | | $275.42 | $389.05 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $389.05 / $660.69 / $954.99
| Professional | AA | $389.05 | $660.69 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $363.08 / $676.08
| Professional | QK | $234.42 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $363.08 / $660.69
| Professional | QX | $229.09 | $363.08 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $257.04 / $354.81 / $676.08
| Professional | QY | $257.04 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $302.00 / $489.78 / $724.44
| Professional | QZ | $302.00 | $489.78 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $100.00 / $162.18 / $457.09
| Professional | AA | $100.00 | $162.18 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $50.12 / $63.10 / $114.82
| Professional | QK | $50.12 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $10.72 / $75.86 / $112.20
| Professional | QX | $10.72 | $75.86 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $138.04 / $371.54
| Professional | QZ | $95.50 | $138.04 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $199.53 / $389.05
| Facility | | $199.53 | $199.53 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $51.29 / $154.88
| Facility | | $38.02 | $51.29 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $60.26 / $79.43 / $95.50
| Professional | AA | $60.26 | $79.43 | $95.50 |
- 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
- $87.10 / $100.00 / $346.74
| Professional | QZ | $87.10 | $100.00 | $346.74 |