- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.02 / $346.74 / $1,000.00
| Facility | | $38.02 | $346.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $446.68 / $851.14 / $1,202.26
| Professional | AA | $446.68 | $851.14 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $407.38 / $478.63 / $691.83
| Professional | QX | $407.38 | $478.63 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $398.11 / $467.74 / $562.34
| Professional | QY | $398.11 | $467.74 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $501.19 / $1,023.29
| Professional | QZ | $100.00 | $501.19 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $288.40
| Professional | QX | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $125.89 / $229.09 / $407.38
| Professional | | $125.89 | $229.09 | $407.38 |
- 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
- Facility
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $3,311.31 / $5,495.41
| Facility | | $158.49 | $3,311.31 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QX | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $151.36
| Professional | QY | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $60.26 / $89.13
| Professional | QZ | $60.26 | $60.26 | $89.13 |