- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $9,549.93
| Facility | AA | $8,317.64 | $8,317.64 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $575.44 / $1,071.52 / $1,949.84
| Professional | AA | $575.44 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $158.49 / $758.58 / $1,698.24
| Professional | QZ | $158.49 | $758.58 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $181.97 / $776.25 / $1,621.81
| Professional | AA | $181.97 | $776.25 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $218.78 / $616.60 / $1,445.44
| Professional | QZ | $218.78 | $616.60 | $1,445.44 |
- 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
- 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
- AA
- Typical Low / Median / Typical High
- $8,317.64 / $8,317.64 / $9,549.93
| Facility | AA | $8,317.64 | $8,317.64 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $549.54 / $1,071.52 / $1,949.84
| Professional | AA | $549.54 | $1,071.52 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $158.49 / $660.69 / $1,584.89
| Professional | QZ | $158.49 | $660.69 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $363.08
| Professional | AA | $79.43 | $79.43 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $75.86 / $85.11 / $269.15
| Professional | QZ | $75.86 | $85.11 | $269.15 |