- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $691.83 / $4,265.80 / $4,265.80
| Facility | AA | $691.83 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $436.52 / $549.54 / $977.24
| Facility | QK | $436.52 | $549.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $208.93 / $912.01 / $1,819.70
| Facility | QX | $208.93 | $912.01 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $660.69 / $660.69 / $660.69
| Facility | QY | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $134.90 / $870.96 / $1,148.15
| Facility | QZ | $134.90 | $870.96 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $562.34 / $1,258.93 / $2,454.71
| Professional | AA | $562.34 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $436.52 / $891.25 / $1,698.24
| Professional | QZ | $436.52 | $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
- $281.84 / $354.81 / $467.74
| Professional | AA | $281.84 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $154.88 / $724.44
| Professional | AA | $79.43 | $154.88 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $79.43 / $87.10 / $630.96
| Professional | QZ | $79.43 | $87.10 | $630.96 |