- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $309.03 / $478.63
| Facility | | $54.95 | $309.03 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | QZ | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $331.13 / $501.19 / $831.76
| Professional | AA | $331.13 | $501.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $426.58
| Professional | QK | $234.42 | $295.12 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $288.40 / $436.52
| Professional | QX | $229.09 | $288.40 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $229.09 / $295.12 / $436.52
| Professional | QY | $229.09 | $295.12 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $512.86 / $630.96
| Professional | QZ | $436.52 | $512.86 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $309.03 / $346.74 / $416.87
| Professional | | $309.03 | $346.74 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $63.10 / $229.09 / $3,311.31
| Facility | | $63.10 | $229.09 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $501.19 / $501.19 / $501.19
| Facility | QZ | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $354.81 / $537.03 / $1,000.00
| Professional | AA | $354.81 | $537.03 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $281.84 / $363.08
| Professional | QK | $234.42 | $281.84 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $223.87 / $269.15 / $346.74
| Professional | QX | $223.87 | $269.15 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $208.93 / $245.47 / $537.03
| Professional | QY | $208.93 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $524.81 / $676.08
| Professional | QZ | $436.52 | $524.81 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $234.42 / $257.04 / $371.54
| Facility | | $234.42 | $257.04 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $457.09 / $3,311.31 / $5,128.61
| Facility | | $457.09 | $3,311.31 | $5,128.61 |
- 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 / $489.78 / $630.96
| Professional | AA | $79.43 | $489.78 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $54.95 / $79.43 / $457.09
| Professional | QZ | $54.95 | $79.43 | $457.09 |