- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $41.69 / $50.12 / $302.00
| Facility | | $41.69 | $50.12 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $524.81 / $1,288.25 / $1,659.59
| Professional | AA | $524.81 | $1,288.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $524.81 / $691.83 / $912.01
| Professional | QX | $524.81 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $363.08
| Professional | QZ | $95.50 | $331.13 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $389.05
| Professional | AA | $100.00 | $100.00 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $63.10 / $63.10 / $194.98
| Professional | QX | $63.10 | $63.10 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $144.54 / $389.05
| Professional | QZ | $100.00 | $144.54 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,162.28 / $3,388.44 / $4,168.69
| Facility | | $3,162.28 | $3,388.44 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $21.38 / $138.04 / $138.04
| Facility | | $21.38 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | | $61.66 | $61.66 | $61.66 |
- 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
- $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 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $42.66 / $263.03 / $4,677.35
| Facility | | $42.66 | $263.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $524.81 / $1,288.25 / $1,659.59
| Professional | AA | $524.81 | $1,288.25 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $691.83 / $691.83 / $691.83
| Professional | QX | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $331.13 / $363.08
| Professional | QZ | $95.50 | $331.13 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $2,511.89 / $5,011.87
| Facility | | $45.71 | $2,511.89 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $89.13
| Professional | QZ | $89.13 | $89.13 | $89.13 |