- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $354.81 / $436.52
| Facility | | $30.20 | $354.81 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $107.15 / $407.38 / $707.95
| Professional | AA | $107.15 | $407.38 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $123.03 / $190.55 / $363.08
| Professional | QX | $123.03 | $190.55 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $190.55 / $190.55 / $190.55
| Professional | QY | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $93.33 / $109.65 / $363.08
| Professional | QZ | $93.33 | $109.65 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $389.05
| Professional | AA | $117.49 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $389.05
| Professional | QX | $117.49 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $389.05
| Professional | QY | $117.49 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $117.49 / $263.03 / $389.05
| Professional | QZ | $117.49 | $263.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $288.40 / $354.81 / $446.68
| Professional | AA | $288.40 | $354.81 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $234.42 / $380.19 / $478.63
| Professional | QX | $234.42 | $380.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $436.52
| Professional | QY | $407.38 | $407.38 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $426.58
| Professional | QZ | $302.00 | $346.74 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $323.59 / $416.87
| Facility | | $47.86 | $323.59 | $416.87 |