- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $446.68 / $1,000.00
| Facility | | $32.36 | $446.68 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $575.44 / $575.44 / $776.25
| Facility | QZ | $575.44 | $575.44 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $524.81 / $676.08 / $1,000.00
| Professional | AA | $524.81 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $281.84 / $575.44 / $851.14
| Professional | QK | $281.84 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $269.15 / $426.58 / $912.01
| Professional | QX | $269.15 | $426.58 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $1,071.52
| Professional | QY | $302.00 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $512.86 / $691.83 / $1,071.52
| Professional | QZ | $512.86 | $691.83 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $102.33 / $131.83 / $331.13
| Professional | AA | $102.33 | $131.83 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $169.82
| Professional | QK | $97.72 | $120.23 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $97.72 / $144.54 / $169.82
| Professional | QX | $97.72 | $144.54 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $144.54 / $144.54 / $144.54
| Professional | QY | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $107.15 / $123.03 / $724.44
| Professional | QZ | $107.15 | $123.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $81.28
| Professional | AA | $79.43 | $79.43 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $275.42
| Professional | QZ | $275.42 | $275.42 | $275.42 |