- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $346.74 / $371.54
| Facility | | $302.00 | $346.74 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $512.86 / $776.25 / $1,096.48
| Professional | AA | $512.86 | $776.25 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $194.98 / $354.81 / $616.60
| Professional | QK | $194.98 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $213.80 / $363.08 / $741.31
| Professional | QX | $213.80 | $363.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $199.53 / $346.74 / $562.34
| Professional | QY | $199.53 | $346.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $234.42 / $457.09 / $758.58
| Professional | QZ | $234.42 | $457.09 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $100.00 / $120.23 / $194.98
| Professional | AA | $100.00 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $85.11
| Professional | QK | $58.88 | $58.88 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $58.88 / $58.88 / $112.20
| Professional | QX | $58.88 | $58.88 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $67.61 / $123.03 / $158.49
| Professional | QY | $67.61 | $123.03 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $97.72 / $120.23 / $288.40
| Professional | QZ | $97.72 | $120.23 | $288.40 |
- 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
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $630.96
| Professional | AA | $81.28 | $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 / $89.13 / $446.68
| Professional | QZ | $75.86 | $89.13 | $446.68 |