- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $47.86 / $251.19
| Facility | | $41.69 | $47.86 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $891.25
| Professional | AA | $346.74 | $489.78 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $190.55 / $331.13 / $467.74
| Professional | QK | $190.55 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $190.55 / $346.74 / $501.19
| Professional | QX | $190.55 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $316.23 / $398.11
| Professional | QY | $239.88 | $316.23 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $125.89 / $338.84 / $467.74
| Professional | QZ | $125.89 | $338.84 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $257.04 / $257.04 / $257.04
| Professional | AA | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | QK | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $58.88
| Professional | QX | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $93.33 / $117.49 / $257.04
| Professional | QZ | $93.33 | $117.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $147.91 / $147.91 / $165.96
| Professional | QX | $147.91 | $147.91 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $295.12 / $338.84 / $446.68
| Professional | QZ | $295.12 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | AA | $79.43 | $79.43 | $79.43 |