- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $478.63 / $562.34 / $602.56
| Facility | | $478.63 | $562.34 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $676.08 / $1,318.26 / $2,137.96
| Professional | AA | $676.08 | $1,318.26 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $380.19 / $575.44 / $851.14
| Professional | QK | $380.19 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $380.19 / $562.34 / $912.01
| Professional | QX | $380.19 | $562.34 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $151.36 / $891.25 / $1,412.54
| Professional | QZ | $151.36 | $891.25 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $213.80 / $251.19 / $977.24
| Professional | AA | $213.80 | $251.19 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- QK
- Typical Low / Median / Typical High
- $89.13 / $158.49 / $660.69
| Professional | QK | $89.13 | $158.49 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $91.20 / $123.03 / $295.12
| Professional | QX | $91.20 | $123.03 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $169.82 / $213.80 / $891.25
| Professional | QZ | $169.82 | $213.80 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- 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
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $81.28 / $81.28 / $1,348.96
| Professional | AA | $81.28 | $81.28 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Professional | QX | $79.43 | $79.43 | $79.43 |