- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $489.78 / $707.95
| Facility | | $44.67 | $489.78 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $91.20 / $91.20 / $97.72
| Facility | QX | $91.20 | $91.20 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $1,862.09
| Facility | QZ | $1,862.09 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $776.25 / $1,288.25 / $2,398.83
| Professional | AA | $776.25 | $1,288.25 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $870.96
| Professional | QK | $338.84 | $537.03 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $331.13 / $524.81 / $851.14
| Professional | QX | $331.13 | $524.81 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $501.19 / $794.33 / $2,089.30
| Professional | QZ | $501.19 | $794.33 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $316.23 / $354.81 / $691.83
| Professional | AA | $316.23 | $354.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $162.18 / $194.98 / $269.15
| Professional | QK | $162.18 | $194.98 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $269.15 / $269.15 / $269.15
| Professional | QX | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | QZ | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $223.87 / $426.58 / $660.69
| Professional | | $223.87 | $426.58 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $851.14
| Professional | AA | $81.28 | $85.11 | $851.14 |