- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | AA | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $436.52 / $436.52 / $436.52
| Facility | QK | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $181.97 / $436.52 / $645.65
| Facility | QX | $181.97 | $436.52 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $954.99 / $954.99 / $954.99
| Facility | QZ | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $676.08 / $1,548.82 / $2,818.38
| Professional | AA | $676.08 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $630.96 / $912.01 / $1,584.89
| Professional | QZ | $630.96 | $912.01 | $1,584.89 |
- 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
- $354.81 / $436.52 / $575.44
| Professional | AA | $354.81 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $478.63 / $1,174.90 / $1,174.90
| Professional | AA | $478.63 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $346.74 / $446.68 / $1,148.15
| Professional | QZ | $346.74 | $446.68 | $1,148.15 |