- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $346.74 / $1,000.00
| Facility | | $38.02 | $346.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $112.20 / $794.33 / $1,148.15
| Professional | AA | $112.20 | $794.33 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $245.47 / $489.78 / $660.69
| Professional | QX | $245.47 | $489.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $389.05 / $426.58 / $537.03
| Professional | QY | $389.05 | $426.58 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $741.31 / $977.24
| Professional | QZ | $95.50 | $741.31 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $102.33 / $102.33 / $407.38
| Professional | AA | $102.33 | $102.33 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $398.11
| Professional | QX | $251.19 | $251.19 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $251.19
| Professional | QY | $251.19 | $251.19 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $141.25
| Professional | QZ | $100.00 | $100.00 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $407.38
| Professional | | $125.89 | $229.09 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QK | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QX | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $52.48
| Facility | QY | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $3,311.31 / $5,495.41
| Facility | | $158.49 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QX | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QY | $151.36 | $151.36 | $151.36 |
- 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
- QZ
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | QZ | $60.26 | $60.26 | $60.26 |