- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $47.86 / $380.19 / $831.76
| Facility | | $47.86 | $380.19 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $616.60 / $1,096.48 / $1,949.84
| Professional | AA | $616.60 | $1,096.48 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $199.53 / $512.86 / $724.44
| Professional | QK | $199.53 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $691.83
| Professional | QX | $354.81 | $512.86 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $151.36 / $676.08 / $954.99
| Professional | QZ | $151.36 | $676.08 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $199.53 / $263.03 / $912.01
| Professional | AA | $199.53 | $263.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $107.15 / $162.18 / $501.19
| Professional | QK | $107.15 | $162.18 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $10.00 / $125.89 / $501.19
| Professional | QX | $10.00 | $125.89 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $331.13 / $524.81 / $1,023.29
| Professional | QZ | $331.13 | $524.81 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $91.20 / $223.87 / $630.96
| Facility | | $91.20 | $223.87 | $630.96 |
- 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 / $81.28 / $85.11
| Professional | AA | $81.28 | $81.28 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QK | $89.13 | $89.13 | $89.13 |