- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $436.52 / $724.44
| Facility | | $281.84 | $436.52 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $524.81 / $891.25 / $1,288.25
| Professional | AA | $524.81 | $891.25 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $407.38 / $478.63 / $691.83
| Professional | QX | $407.38 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $562.34
| Professional | QY | $398.11 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $741.31 / $1,023.29
| Professional | QZ | $100.00 | $741.31 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | QX | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $107.15 / $125.89 / $125.89
| Professional | QZ | $107.15 | $125.89 | $125.89 |
- 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
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- 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
- $346.74 / $346.74 / $346.74
| Professional | AA | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QX | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QY | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $89.13 / $346.74 / $346.74
| Professional | QZ | $89.13 | $346.74 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $177.83
| Facility | | $81.28 | $81.28 | $177.83 |