- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $870.96 / $1,318.26
| Facility | | $40.74 | $870.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $144.54 / $831.76 / $1,412.54
| Professional | AA | $144.54 | $831.76 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $134.90 / $338.84 / $588.84
| Professional | QX | $134.90 | $338.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $588.84
| Professional | QY | $239.88 | $346.74 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $138.04 / $691.83 / $1,202.26
| Professional | QZ | $138.04 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $123.03 / $467.74 / $776.25
| Professional | AA | $123.03 | $467.74 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $331.13 / $338.84 / $549.54
| Professional | QX | $331.13 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | QY | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $165.96 / $912.01
| Professional | QZ | $97.72 | $165.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $371.54
| Professional | | $89.13 | $158.49 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $138.04 / $251.19 / $416.87
| Professional | | $138.04 | $251.19 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Facility | | $141.25 | $141.25 | $141.25 |
- 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
- $1,819.70 / $3,630.78 / $5,623.41
| Facility | | $1,819.70 | $3,630.78 | $5,623.41 |
- 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 / $251.19 / $537.03
| Professional | AA | $79.43 | $251.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | QX | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $85.11 / $346.74
| Professional | QZ | $60.26 | $85.11 | $346.74 |