- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $245.47 / $245.47 / $245.47
| Facility | QX | $245.47 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $537.03 / $812.83 / $1,513.56
| Professional | AA | $537.03 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $173.78 / $354.81 / $954.99
| Professional | AA | $173.78 | $354.81 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | QK | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | QX | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Facility | QY | $52.48 | $52.48 | $52.48 |