- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $346.74 / $1,000.00
| Facility | | $38.02 | $346.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $831.76 / $831.76 / $831.76
| Facility | QZ | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $446.68 / $776.25 / $1,258.93
| Professional | AA | $446.68 | $776.25 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $645.65
| Professional | QK | $239.88 | $354.81 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $346.74 / $660.69
| Professional | QX | $229.09 | $346.74 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $354.81 / $616.60
| Professional | QY | $239.88 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $346.74 / $562.34 / $1,202.26
| Professional | QZ | $346.74 | $562.34 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $138.04 / $467.74 / $676.08
| Professional | AA | $138.04 | $467.74 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $229.09 / $331.13 / $389.05
| Professional | QK | $229.09 | $331.13 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $162.18 / $338.84 / $512.86
| Professional | QX | $162.18 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $194.98 / $234.42 / $389.05
| Professional | QY | $194.98 | $234.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $169.82 / $562.34
| Professional | QZ | $100.00 | $169.82 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $100.00 / $234.42
| Professional | | $56.23 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $251.19 / $389.05
| Professional | | $104.71 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- 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 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $3,311.31 / $5,495.41
| Facility | | $158.49 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QK | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QX | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QY | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $263.03 / $630.96
| Professional | AA | $79.43 | $263.03 | $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 / $346.74 / $446.68
| Professional | QZ | $75.86 | $346.74 | $446.68 |