- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $251.19 / $251.19 / $338.84
| Facility | QX | $251.19 | $251.19 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $407.38 / $741.31 / $1,096.48
| Professional | AA | $407.38 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $660.69
| Professional | QK | $234.42 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $234.42 / $346.74 / $660.69
| Professional | QX | $234.42 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $346.74 / $660.69
| Professional | QY | $239.88 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $794.33
| Professional | QZ | $380.19 | $562.34 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $123.03 / $457.09
| Professional | AA | $81.28 | $123.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $257.04
| Professional | QX | $229.09 | $229.09 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $117.49 / $389.05
| Professional | QZ | $97.72 | $117.49 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $34.67 / $81.28 / $3,715.35
| Facility | | $34.67 | $81.28 | $3,715.35 |
- 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
- AA
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $630.96
| Professional | AA | $81.28 | $89.13 | $630.96 |
- 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
- $75.86 / $281.84 / $446.68
| Professional | QZ | $75.86 | $281.84 | $446.68 |