- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $239.88 / $467.74 / $1,348.96
| Facility | | $239.88 | $467.74 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $97.72 / $288.40 / $691.83
| Facility | QX | $97.72 | $288.40 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $134.90 / $616.60 / $1,071.52
| Professional | AA | $134.90 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $60.26 / $316.23 / $562.34
| Professional | QX | $60.26 | $316.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $316.23 / $446.68
| Professional | QY | $234.42 | $316.23 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $131.83 / $549.54 / $933.25
| Professional | QZ | $131.83 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $120.23 / $371.54 / $776.25
| Professional | AA | $120.23 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $66.07 / $234.42 / $512.86
| Professional | QX | $66.07 | $234.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | QY | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $234.42 / $912.01
| Professional | QZ | $97.72 | $234.42 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $2,398.83 / $4,786.30
| Facility | | $1,698.24 | $2,398.83 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5,623.41 / $5,623.41 / $9,120.11
| Facility | | $5,623.41 | $5,623.41 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $275.42 / $275.42 / $346.74
| Professional | QZ | $275.42 | $275.42 | $346.74 |
- 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 |