- Facility/Professional
- Facility
- Modifier
- AA
- Typical Low / Median / Typical High
- $933.25 / $933.25 / $933.25
| Facility | AA | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $489.78 / $588.84 / $977.24
| Facility | QK | $489.78 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $446.68 / $1,023.29 / $1,148.15
| Facility | QX | $446.68 | $1,023.29 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- QY
- Typical Low / Median / Typical High
- $478.63 / $478.63 / $478.63
| Facility | QY | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,122.02 / $1,819.70 / $1,819.70
| Facility | QZ | $1,122.02 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $776.25 / $1,584.89 / $2,570.40
| Professional | AA | $776.25 | $1,584.89 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $691.83 / $1,148.15 / $2,454.71
| Professional | QZ | $691.83 | $1,148.15 | $2,454.71 |
- 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
- $416.87 / $524.81 / $691.83
| Professional | AA | $416.87 | $524.81 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $81.28 / $1,000.00
| Professional | AA | $79.43 | $81.28 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $416.87 / $1,862.09 / $1,862.09
| Professional | QZ | $416.87 | $1,862.09 | $1,862.09 |