- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $346.74 / $933.25
| Facility | | $44.67 | $346.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Facility | AA | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $104.71 / $263.03
| Facility | QK | $89.13 | $104.71 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $97.72 / $275.42 / $660.69
| Facility | QX | $97.72 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | QY | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $18.62 / $501.19 / $1,288.25
| Facility | QZ | $18.62 | $501.19 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $144.54 / $660.69 / $1,174.90
| Professional | AA | $144.54 | $660.69 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $87.10 / $309.03 / $537.03
| Professional | QX | $87.10 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $302.00 / $562.34
| Professional | QY | $234.42 | $302.00 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $123.03 / $549.54 / $954.99
| Professional | QZ | $123.03 | $549.54 | $954.99 |
- 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
- QY
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Professional | QY | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $251.19 / $537.03
| Professional | AA | $79.43 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $162.18
| Professional | QX | $70.79 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $128.82 / $134.90 / $346.74
| Professional | QY | $128.82 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $85.11 / $275.42
| Professional | QZ | $79.43 | $85.11 | $275.42 |