- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $302.00 / $660.69
| Facility | | $30.20 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $302.00 / $575.44 / $1,000.00
| Professional | AA | $302.00 | $575.44 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $218.78 / $302.00 / $489.78
| Professional | QK | $218.78 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $213.80 / $309.03 / $562.34
| Professional | QX | $213.80 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $208.93 / $309.03 / $457.09
| Professional | QY | $208.93 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $302.00 / $512.86 / $660.69
| Professional | QZ | $302.00 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $467.74
| Professional | AA | $446.68 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $446.68 / $467.74 / $467.74
| Professional | QZ | $446.68 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $354.81 / $426.58
| Professional | | $208.93 | $354.81 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $2,398.83 / $4,786.30
| Facility | | $45.71 | $2,398.83 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $64.57 / $97.72
| Facility | | $21.38 | $64.57 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $245.47
| Professional | AA | $79.43 | $81.28 | $245.47 |
- 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 / $257.04 / $281.84
| Professional | QZ | $87.10 | $257.04 | $281.84 |