- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $588.84 / $1,000.00
| Facility | | $42.66 | $588.84 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $9.77 / $446.68 / $812.83
| Facility | AA | $9.77 | $446.68 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $524.81
| Facility | QK | $446.68 | $446.68 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $112.20 / $295.12 / $416.87
| Facility | QX | $112.20 | $295.12 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $186.21 / $186.21 / $275.42
| Facility | QY | $186.21 | $186.21 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $724.44 / $1,202.26 / $1,479.11
| Facility | QZ | $724.44 | $1,202.26 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $380.19 / $549.54 / $660.69
| Professional | AA | $380.19 | $549.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $208.93 / $263.03 / $331.13
| Professional | QK | $208.93 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $213.80 / $263.03 / $331.13
| Professional | QX | $213.80 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $316.23
| Professional | QY | $208.93 | $245.47 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $338.84 / $478.63 / $602.56
| Professional | QZ | $338.84 | $478.63 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $42.66 / $275.42
| Facility | | $29.51 | $42.66 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $54.95 / $87.10 / $234.42
| Professional | QZ | $54.95 | $87.10 | $234.42 |