- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $912.01 / $3,981.07
| Facility | | $263.03 | $912.01 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $741.31 / $1,258.93 / $2,630.27
| Professional | AA | $741.31 | $1,258.93 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $251.19 / $562.34 / $933.25
| Professional | QK | $251.19 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $331.13 / $575.44 / $912.01
| Professional | QX | $331.13 | $575.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $181.97 / $933.25 / $1,412.54
| Professional | QZ | $181.97 | $933.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $316.23 / $831.76 / $1,548.82
| Professional | AA | $316.23 | $831.76 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $107.15 / $467.74 / $724.44
| Professional | QK | $107.15 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $114.82 / $467.74 / $831.76
| Professional | QX | $114.82 | $467.74 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $162.18 / $1,047.13 / $1,445.44
| Professional | QZ | $162.18 | $1,047.13 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- 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
- $81.28 / $85.11 / $851.14
| Professional | AA | $81.28 | $85.11 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $245.47
| Professional | QK | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | QX | $79.43 | $79.43 | $79.43 |