- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $870.96 / $1,621.81 / $1,621.81
| Facility | AA | $870.96 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $302.00 / $331.13 / $977.24
| Facility | QK | $302.00 | $331.13 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $245.47 / $851.14 / $1,513.56
| Facility | QX | $245.47 | $851.14 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | QY | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $549.54 / $1,445.44 / $1,905.46
| Facility | QZ | $549.54 | $1,445.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $616.60 / $1,174.90 / $2,238.72
| Professional | AA | $616.60 | $1,174.90 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $416.87 / $891.25 / $1,698.24
| Professional | QZ | $416.87 | $891.25 | $1,698.24 |
- 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
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $416.87 / $524.81 / $691.83
| Professional | AA | $416.87 | $524.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $346.74 / $1,096.48
| Professional | AA | $79.43 | $346.74 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $87.10
| Professional | QZ | $75.86 | $85.11 | $87.10 |