- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $616.60 / $1,479.11 / $1,621.81
| Professional | AA | $616.60 | $1,479.11 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $309.03 / $354.81 / $537.03
| Professional | QX | $309.03 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $102.33 / $363.08 / $398.11
| Professional | QZ | $102.33 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $389.05 / $389.05 / $457.09
| Professional | AA | $389.05 | $389.05 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | QX | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $162.18 / $162.18 / $162.18
| Professional | QY | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $389.05
| Professional | QZ | $100.00 | $100.00 | $389.05 |
- 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
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $1,122.02 / $1,479.11 / $1,621.81
| Professional | AA | $1,122.02 | $1,479.11 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $309.03 / $354.81 / $537.03
| Professional | QX | $309.03 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $102.33 / $363.08 / $398.11
| Professional | QZ | $102.33 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $60.26
| Professional | QZ | $60.26 | $60.26 | $60.26 |