- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $645.65 / $1,995.26
| Facility | | $44.67 | $645.65 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $891.25
| Facility | QK | $141.25 | $141.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $91.20 / $245.47 / $537.03
| Facility | QX | $91.20 | $245.47 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,862.09 / $1,862.09 / $2,041.74
| Facility | QZ | $1,862.09 | $1,862.09 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $691.83 / $1,348.96 / $2,454.71
| Professional | AA | $691.83 | $1,348.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $323.59 / $537.03 / $831.76
| Professional | QK | $323.59 | $537.03 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $338.84 / $537.03 / $812.83
| Professional | QX | $338.84 | $537.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $933.25 / $1,778.28
| Professional | QZ | $436.52 | $933.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,388.44 / $4,168.69
| Facility | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $87.10
| Facility | | $61.66 | $61.66 | $87.10 |
- 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
- $562.34 / $707.95 / $933.25
| Professional | AA | $562.34 | $707.95 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $1,348.96
| Professional | AA | $81.28 | $85.11 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $436.52
| Professional | QK | $89.13 | $89.13 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | QX | $79.43 | $79.43 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $75.86 / $436.52 / $562.34
| Professional | QZ | $75.86 | $436.52 | $562.34 |