- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $422.30 / $1,006.40 / $1,076.14
| Professional | AA | $422.30 | $1,006.40 | $1,076.14 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $212.64 / $212.64 / $296.70
| Professional | AA | $212.64 | $212.64 | $296.70 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Professional | QZ | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $140.00 / $234.00 / $340.72
| Professional | AA | $140.00 | $234.00 | $340.72 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $112.00 / $160.00 / $242.00
| Professional | QZ | $112.00 | $160.00 | $242.00 |