- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | QZ | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $331.13 / $831.76 / $1,148.15
| Professional | AA | $331.13 | $831.76 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $239.88 / $323.59 / $549.54
| Professional | QX | $239.88 | $323.59 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $234.42 / $295.12 / $512.86
| Professional | QY | $234.42 | $295.12 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $363.08 / $549.54 / $933.25
| Professional | QZ | $363.08 | $549.54 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $389.05
| Professional | AA | $123.03 | $123.03 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $229.09 / $229.09 / $229.09
| Professional | QX | $229.09 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $234.42 / $234.42 / $234.42
| Professional | QZ | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $141.25 / $3,715.35
| Facility | | $81.28 | $141.25 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $52.48
| Facility | QK | $39.81 | $39.81 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $52.48
| Facility | QX | $39.81 | $39.81 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $39.81 / $39.81 / $52.48
| Facility | QY | $39.81 | $39.81 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $416.87 / $537.03
| Professional | AA | $79.43 | $416.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $85.11 / $85.11 / $85.11
| Professional | QX | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $85.11
| Professional | QZ | $79.43 | $79.43 | $85.11 |