- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $489.78 / $676.08
| Facility | | $41.69 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $691.83 / $977.24 / $1,698.24
| Professional | AA | $691.83 | $977.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $234.42 / $512.86 / $707.95
| Professional | QK | $234.42 | $512.86 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $302.00 / $501.19 / $724.44
| Professional | QX | $302.00 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $676.08 / $812.83 / $1,148.15
| Professional | QZ | $676.08 | $812.83 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $234.42 / $275.42 / $354.81
| Professional | AA | $234.42 | $275.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $162.18
| Professional | QK | $87.10 | $87.10 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $10.00 / $87.10 / $457.09
| Professional | QX | $10.00 | $87.10 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $251.19
| Professional | QZ | $234.42 | $234.42 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $81.28 / $3,019.95
| Facility | | $42.66 | $81.28 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QK | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QX | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $39.81
| Facility | QY | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $1,047.13 / $1,047.13 / $1,047.13
| Professional | AA | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $588.84 / $588.84 / $588.84
| Professional | QZ | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $81.28
| Professional | AA | $81.28 | $81.28 | $81.28 |