- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $39.81 / $1,023.29 / $2,137.96
| Facility | | $39.81 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | AA | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $912.01
| Professional | QX | $524.81 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $2,187.76
| Professional | QZ | $95.50 | $331.13 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $1,047.13
| Professional | AA | $147.91 | $147.91 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $346.74
| Professional | QX | $63.10 | $63.10 | $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
- $100.00 / $147.91 / $912.01
| Professional | QZ | $100.00 | $147.91 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- 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
- $79.43 / $79.43 / $79.43
| Professional | AA | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $30.20
| Professional | QX | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QZ | $89.13 | $89.13 | $89.13 |