- Facility/Professional
- Facility
- Modifier
- AA
- Low / Median / High Price
- $4,626.31 / $4,626.31 / $4,626.31
| Facility | AA | $4,626.31 | $4,626.31 | $4,626.31 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $457.74 / $457.74 / $621.37
| Facility | QK | $457.74 | $457.74 | $621.37 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $431.09 / $614.91 / $859.57
| Facility | QX | $431.09 | $614.91 | $859.57 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $1,483.92 / $1,483.92 / $1,483.92
| Facility | QY | $1,483.92 | $1,483.92 | $1,483.92 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Low / Median / High Price
- $1,120.34 / $1,431.72 / $1,565.81
| Facility | QZ | $1,120.34 | $1,431.72 | $1,565.81 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $554.88 / $1,120.00 / $1,750.00
| Professional | AA | $554.88 | $1,120.00 | $1,750.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $413.38 / $833.04 / $1,109.70
| Professional | QZ | $413.38 | $833.04 | $1,109.70 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $411.42 / $481.02 / $517.96
| Professional | AA | $411.42 | $481.02 | $517.96 |