- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $1,230.27 / $1,513.56 / $1,621.81
| Professional | AA | $1,230.27 | $1,513.56 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $295.12 / $363.08 / $630.96
| Professional | QX | $295.12 | $363.08 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | QY | $416.87 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $331.13 / $467.74
| Professional | QZ | $100.00 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $457.09 / $457.09 / $457.09
| Professional | AA | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Professional | QX | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $194.98 / $194.98 / $194.98
| Professional | QY | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $120.23 / $323.59 / $457.09
| Professional | QZ | $120.23 | $323.59 | $457.09 |
- 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
- $1,230.27 / $1,513.56 / $1,621.81
| Professional | AA | $1,230.27 | $1,513.56 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $295.12 / $323.59 / $467.74
| Professional | QX | $295.12 | $323.59 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $331.13 / $467.74
| Professional | QZ | $100.00 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $70.79 / $89.13 / $89.13
| Professional | QZ | $70.79 | $89.13 | $89.13 |