- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $338.84 / $794.33
| Facility | | $30.20 | $338.84 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $331.13 / $588.84 / $954.99
| Professional | AA | $331.13 | $588.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $537.03
| Professional | QK | $234.42 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $234.42 / $323.59 / $562.34
| Professional | QX | $234.42 | $323.59 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $512.86
| Professional | QY | $239.88 | $323.59 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $676.08
| Professional | QZ | $407.38 | $524.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $102.33 / $239.88 / $676.08
| Professional | AA | $102.33 | $239.88 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $51.29 / $117.49 / $338.84
| Professional | QK | $51.29 | $117.49 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $61.66 / $125.89 / $389.05
| Professional | QX | $61.66 | $125.89 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $50.12 / $109.65 / $398.11
| Professional | QY | $50.12 | $109.65 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $562.34
| Professional | QZ | $102.33 | $181.97 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $190.55 / $407.38 / $660.69
| Professional | | $190.55 | $407.38 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QK | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QX | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $165.96
| Professional | QY | $123.03 | $123.03 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,737.80 / $3,019.95 / $5,011.87
| Facility | | $1,737.80 | $3,019.95 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $89.13 / $89.13
| Professional | AA | $81.28 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $70.79 / $85.11 / $223.87
| Professional | QX | $70.79 | $85.11 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $234.42
| Professional | QZ | $54.95 | $79.43 | $234.42 |