- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $131.83 / $1,000.00 / $1,905.46
| Professional | AA | $131.83 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $302.00 / $426.58 / $707.95
| Professional | QX | $302.00 | $426.58 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- QY
- Typical Low / Median / Typical High
- $407.38 / $524.81 / $1,000.00
| Professional | QY | $407.38 | $524.81 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $100.00 / $741.31 / $977.24
| Professional | QZ | $100.00 | $741.31 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $131.83 / $131.83 / $131.83
| Professional | AA | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $75.86 / $75.86 / $75.86
| Professional | QX | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Typical Low / Median / Typical High
- $123.03 / $144.54 / $144.54
| Professional | QZ | $123.03 | $144.54 | $144.54 |
- 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
- $512.86 / $645.65 / $1,174.90
| Professional | AA | $512.86 | $645.65 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $616.60 / $616.60 / $616.60
| Professional | QX | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- AA
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | AA | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- QX
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Professional | QX | $346.74 | $346.74 | $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
- $89.13 / $346.74 / $346.74
| Professional | QZ | $89.13 | $346.74 | $346.74 |