- Facility/Professional
- Facility
- Modifier
- QK
- Typical Low / Median / Typical High
- $1,023.29 / $1,023.29 / $1,023.29
| Facility | QK | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $407.38 / $407.38 / $2,398.83
| Facility | QX | $407.38 | $407.38 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $426.58 / $1,479.11 / $2,511.89
| Professional | AA | $426.58 | $1,479.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $398.11 / $645.65 / $954.99
| Professional | QX | $398.11 | $645.65 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $537.03 / $812.83 / $891.25
| Professional | QY | $537.03 | $812.83 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $1,000.00 / $1,905.46 / $2,691.53
| Professional | QZ | $1,000.00 | $1,905.46 | $2,691.53 |
- 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
- QY
- Typical Low / Median / Typical High
- $363.08 / $363.08 / $363.08
| Professional | QY | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $416.87
| Professional | AA | $79.43 | $79.43 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $416.87 / $416.87 / $416.87
| Professional | QX | $416.87 | $416.87 | $416.87 |
- 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
- $812.83 / $812.83 / $812.83
| Professional | QZ | $812.83 | $812.83 | $812.83 |