- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $269.15 / $977.24
| Facility | | $47.86 | $269.15 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $407.38 / $602.56 / $933.25
| Professional | AA | $407.38 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $213.80 / $323.59 / $616.60
| Professional | QK | $213.80 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $223.87 / $323.59 / $645.65
| Professional | QX | $223.87 | $323.59 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $251.19 / $331.13 / $691.83
| Professional | QY | $251.19 | $331.13 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $269.15 / $489.78 / $758.58
| Professional | QZ | $269.15 | $489.78 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $194.98
| Professional | AA | $97.72 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $58.88 / $85.11 / $275.42
| Professional | QK | $58.88 | $85.11 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $10.72 / $83.18 / $275.42
| Professional | QX | $10.72 | $83.18 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $138.04 / $457.09
| Professional | QZ | $97.72 | $138.04 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $112.20 / $316.23
| Facility | | $41.69 | $112.20 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- 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
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $89.13
| Professional | AA | $81.28 | $81.28 | $89.13 |
- 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
- $275.42 / $275.42 / $275.42
| Professional | QZ | $275.42 | $275.42 | $275.42 |