- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $707.95 / $1,174.90
| Facility | | $446.68 | $707.95 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $239.88 / $1,737.80 / $2,630.27
| Professional | AA | $239.88 | $1,737.80 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $323.59 / $524.81 / $776.25
| Professional | QK | $323.59 | $524.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $331.13 / $524.81 / $794.33
| Professional | QX | $331.13 | $524.81 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $1,659.59 / $2,041.74
| Professional | QZ | $436.52 | $1,659.59 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $114.82 / $131.83 / $549.54
| Professional | QX | $114.82 | $131.83 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Professional | QZ | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $50,118.72 / $53,703.18
| Facility | | $61.66 | $50,118.72 | $53,703.18 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $363.08 / $977.24 / $1,258.93
| Professional | AA | $363.08 | $977.24 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $478.63 / $1,047.13 / $1,230.27
| Professional | QK | $478.63 | $1,047.13 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $691.83 / $1,000.00 / $1,202.26
| Professional | QX | $691.83 | $1,000.00 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $831.76 / $851.14 / $1,071.52
| Professional | QZ | $831.76 | $851.14 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $50,118.72 / $53,703.18 / $75,857.76
| Facility | | $50,118.72 | $53,703.18 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $85.11 / $1,348.96
| Professional | AA | $81.28 | $85.11 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | QK | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | QX | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $562.34 / $562.34 / $562.34
| Professional | QZ | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $309.03
| Facility | | $141.25 | $141.25 | $309.03 |