- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Facility | AA | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $398.11 / $398.11 / $812.83
| Facility | QK | $398.11 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | QX | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Facility | QY | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $380.19 / $741.31 / $1,202.26
| Professional | AA | $380.19 | $741.31 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $354.81 / $512.86 / $676.08
| Professional | QZ | $354.81 | $512.86 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $165.96 / $165.96 / $213.80
| Professional | AA | $165.96 | $165.96 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $102.33 / $120.23 / $275.42
| Professional | QZ | $102.33 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $93.33 / $213.80 / $309.03
| Professional | AA | $93.33 | $213.80 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $93.33 / $213.80 / $309.03
| Professional | QZ | $93.33 | $213.80 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $61.66 / $61.66 / $61.66
| Facility | QZ | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $302.00 / $524.81 / $977.24
| Professional | AA | $302.00 | $524.81 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $295.12 / $371.54 / $537.03
| Professional | QZ | $295.12 | $371.54 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | AA | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $87.10 / $87.10 / $87.10
| Professional | QZ | $87.10 | $87.10 | $87.10 |