- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $407.38 / $501.19 / $776.25
| Facility | | $407.38 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $1,819.70
| Professional | AA | $676.08 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $346.74 / $501.19 / $707.95
| Professional | QK | $346.74 | $501.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $724.44
| Professional | QX | $354.81 | $512.86 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,818.38
| Professional | QZ | $2,290.87 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $501.19 / $562.34 / $676.08
| Professional | | $501.19 | $562.34 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $371.54 / $4,466.84
| Facility | | $162.18 | $371.54 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $676.08 / $1,000.00 / $1,659.59
| Professional | AA | $676.08 | $1,000.00 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $109.65 / $416.87 / $575.44
| Professional | QK | $109.65 | $416.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $346.74 / $489.78 / $707.95
| Professional | QX | $346.74 | $489.78 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $2,290.87 / $2,290.87 / $2,818.38
| Professional | QZ | $2,290.87 | $2,290.87 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $416.87 / $588.84
| Facility | | $380.19 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $724.44 / $3,311.31 / $5,495.41
| Facility | | $724.44 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | QK | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $239.88 / $239.88 / $239.88
| Professional | QX | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $331.13
| Professional | QK | $229.09 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $269.15 / $331.13
| Professional | QX | $229.09 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $1,348.96
| Professional | AA | $79.43 | $79.43 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | QX | $79.43 | $79.43 | $79.43 |