- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $562.34 / $776.25 / $776.25
| Facility | QX | $562.34 | $776.25 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $870.96 / $2,454.71 / $3,090.30
| Professional | AA | $870.96 | $2,454.71 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $870.96 / $1,548.82 / $3,311.31
| Professional | QZ | $870.96 | $1,548.82 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $851.14 / $851.14 / $1,096.48
| Professional | AA | $851.14 | $851.14 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $354.81 / $354.81 / $1,174.90
| Professional | QZ | $354.81 | $354.81 | $1,174.90 |