- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $30.20 / $489.78 / $977.24
| Facility | | $30.20 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $245.47 / $245.47 / $3,090.30
| Facility | QX | $245.47 | $245.47 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $870.96 / $1,380.38 / $2,137.96
| Professional | AA | $870.96 | $1,380.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $323.59 / $602.56 / $933.25
| Professional | QK | $323.59 | $602.56 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $338.84 / $575.44 / $912.01
| Professional | QX | $338.84 | $575.44 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $870.96 / $1,230.27
| Professional | QZ | $436.52 | $870.96 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $407.38 / $741.31 / $1,412.54
| Professional | AA | $407.38 | $741.31 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $100.00 / $309.03 / $812.83
| Professional | QK | $100.00 | $309.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $102.33 / $512.86 / $812.83
| Professional | QX | $102.33 | $512.86 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $537.03 / $630.96 / $1,737.80
| Professional | QZ | $537.03 | $630.96 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $33.11 / $1,949.84 / $4,677.35
| Facility | | $33.11 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $851.14
| Professional | AA | $81.28 | $81.28 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QK | $89.13 | $89.13 | $89.13 |
- 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 |