- Facility/Professional
- Facility
- Modifier
- AA
- Low / Median / High Price
- $6,949.60 / $6,949.60 / $6,949.60
| Facility | AA | $6,949.60 | $6,949.60 | $6,949.60 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $298.80 / $321.17 / $410.87
| Facility | QK | $298.80 | $321.17 | $410.87 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $390.32 / $390.32 / $828.24
| Facility | QX | $390.32 | $390.32 | $828.24 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $571.57 / $571.57 / $647.86
| Facility | QY | $571.57 | $571.57 | $647.86 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Low / Median / High Price
- $909.00 / $1,326.00 / $1,705.95
| Facility | QZ | $909.00 | $1,326.00 | $1,705.95 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $634.09 / $980.00 / $1,400.00
| Professional | AA | $634.09 | $980.00 | $1,400.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $480.35 / $624.22 / $752.52
| Professional | QZ | $480.35 | $624.22 | $752.52 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $411.42 / $481.02 / $517.96
| Professional | AA | $411.42 | $481.02 | $517.96 |