- 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
- $117.49 / $912.01 / $1,258.93
| Professional | AA | $117.49 | $912.01 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $190.55 / $467.74 / $630.96
| Professional | QX | $190.55 | $467.74 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $190.55 / $426.58 / $537.03
| Professional | QY | $190.55 | $426.58 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $95.50 / $776.25 / $977.24
| Professional | QZ | $95.50 | $776.25 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $66.07 / $66.07 / $436.52
| Professional | QX | $66.07 | $66.07 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Professional | QY | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $104.71 / $123.03 / $125.89
| Professional | QZ | $104.71 | $123.03 | $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
- $346.74 / $346.74 / $346.74
| Professional | QZ | $346.74 | $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 |