- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $309.03 / $467.74
| Facility | | $41.69 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $446.68 / $891.25 / $1,380.38
| Professional | AA | $446.68 | $891.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $416.87 / $524.81 / $912.01
| Professional | QX | $416.87 | $524.81 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $562.34
| Professional | QY | $398.11 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $354.81 / $2,187.76
| Professional | QZ | $95.50 | $354.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,388.44 / $4,168.69
| Facility | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $50,118.72
| Facility | | $61.66 | $61.66 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QK | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QX | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $30.90 / $30.90 / $30.90
| Facility | QY | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $354.81 / $436.52 / $575.44
| Professional | AA | $354.81 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $346.74
| Professional | AA | $79.43 | $79.43 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $346.74
| Professional | QX | $30.20 | $30.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QY | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $89.13
| Professional | QZ | $60.26 | $89.13 | $89.13 |