- Facility/Professional
- Facility
- Modifier
- QX
- Typical Low / Median / Typical High
- $724.44 / $724.44 / $724.44
| Facility | QX | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $177.83 / $977.24 / $1,737.80
| Professional | AA | $177.83 | $977.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $295.12 / $389.05 / $660.69
| Professional | QX | $295.12 | $389.05 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $407.38 / $416.87 / $1,000.00
| Professional | QY | $407.38 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $354.81 / $912.01
| Professional | QZ | $100.00 | $354.81 | $912.01 |
- 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
- $354.81 / $436.52 / $575.44
| Professional | AA | $354.81 | $436.52 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $346.74
| Professional | AA | $79.43 | $79.43 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $30.20 / $30.20 / $346.74
| Professional | QX | $30.20 | $30.20 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QY | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $60.26 / $89.13 / $89.13
| Professional | QZ | $60.26 | $89.13 | $89.13 |