- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $309.03 / $426.58
| Facility | | $41.69 | $309.03 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $128.82 / $562.34 / $1,122.02
| Professional | AA | $128.82 | $562.34 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $69.18 / $275.42 / $389.05
| Professional | QX | $69.18 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $331.13
| Professional | QY | $234.42 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $173.78 / $512.86 / $660.69
| Professional | QZ | $173.78 | $512.86 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $29.51 / $29.51 / $29.51
| Professional | AA | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $109.65 / $109.65 / $109.65
| Professional | QX | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $457.09
| Professional | QZ | $97.72 | $138.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $2,754.23 / $3,235.94
| Facility | | $81.28 | $2,754.23 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QK | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QX | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QY | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $467.74 / $467.74 / $467.74
| Professional | QZ | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $537.03
| Professional | AA | $70.79 | $70.79 | $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
- $79.43 / $79.43 / $89.13
| Professional | QZ | $79.43 | $79.43 | $89.13 |