- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $363.08 / $776.25
| Facility | | $38.02 | $363.08 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $338.84 / $489.78 / $977.24
| Professional | AA | $338.84 | $489.78 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $208.93 / $208.93 / $263.03
| Professional | QK | $208.93 | $208.93 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | QX | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | QY | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $588.84 / $691.83
| Professional | QZ | $100.00 | $588.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $102.33 / $169.82 / $645.65
| Professional | AA | $102.33 | $169.82 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QK | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $89.13
| Professional | QX | $60.26 | $60.26 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $218.78
| Professional | QZ | $97.72 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $323.59 / $537.03
| Professional | | $151.36 | $323.59 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $630.96
| Professional | AA | $79.43 | $81.28 | $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 / $446.68 / $446.68
| Professional | QZ | $75.86 | $446.68 | $446.68 |