- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $724.44
| Facility | | $281.84 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $147.91 / $954.99 / $1,445.44
| Professional | AA | $147.91 | $954.99 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $218.78 / $323.59 / $602.56
| Professional | QX | $218.78 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $223.87 / $446.68 / $616.60
| Professional | QY | $223.87 | $446.68 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $138.04 / $870.96 / $1,230.27
| Professional | QZ | $138.04 | $870.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $588.84
| Professional | AA | $389.05 | $389.05 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $75.86 / $102.33 / $295.12
| Professional | QX | $75.86 | $102.33 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $457.09
| Professional | QZ | $117.49 | $117.49 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $50,118.72 / $53,703.18
| Facility | | $61.66 | $50,118.72 | $53,703.18 |
- 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
- 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
- $177.83 / $489.78 / $645.65
| Professional | AA | $177.83 | $489.78 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $147.91 / $549.54 / $645.65
| Professional | QX | $147.91 | $549.54 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $169.82 / $537.03 / $562.34
| Professional | QY | $169.82 | $537.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $147.91 / $208.93 / $467.74
| Professional | QZ | $147.91 | $208.93 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $346.74 / $537.03
| Professional | AA | $79.43 | $346.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $346.74
| Professional | QX | $85.11 | $85.11 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QY | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QZ | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $177.83
| Facility | | $81.28 | $81.28 | $177.83 |