- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $40.74 / $562.34 / $7,413.10
| Facility | | $40.74 | $562.34 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $812.83 / $1,698.24 / $2,691.53
| Professional | AA | $812.83 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $346.74 / $575.44 / $977.24
| Professional | QK | $346.74 | $575.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $354.81 / $562.34 / $912.01
| Professional | QX | $354.81 | $562.34 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $223.87 / $1,584.89 / $2,398.83
| Professional | QZ | $223.87 | $1,584.89 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $177.83 / $758.58 / $1,548.82
| Professional | AA | $177.83 | $758.58 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $1,000.00
| Professional | QK | $602.56 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $102.33 / $602.56 / $1,000.00
| Professional | QX | $102.33 | $602.56 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $331.13 / $331.13 / $331.13
| Professional | QZ | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $102.33 / $181.97 / $426.58
| Professional | | $102.33 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $371.54 / $645.65
| Professional | | $199.53 | $371.54 | $645.65 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $3,311.31 / $5,495.41
| Facility | | $158.49 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | QK | $239.88 | $239.88 | $239.88 |
- 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
- AA
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $1,348.96
| Professional | AA | $85.11 | $85.11 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QK | $89.13 | $89.13 | $89.13 |