- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $309.03 / $457.09
| Facility | | $41.69 | $309.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $114.82 / $758.58 / $1,258.93
| Professional | AA | $114.82 | $758.58 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $186.21 / $426.58 / $794.33
| Professional | QX | $186.21 | $426.58 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $190.55 / $426.58 / $537.03
| Professional | QY | $190.55 | $426.58 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $93.33 / $309.03 / $870.96
| Professional | QZ | $93.33 | $309.03 | $870.96 |
- 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
- $346.74 / $346.74 / $346.74
| Professional | QX | $346.74 | $346.74 | $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 / $75.86 / $79.43
| Professional | QZ | $60.26 | $75.86 | $79.43 |