- Facility/Professional
- Facility
- Modifier
- AA
- Low / Median / High Price
- $2,868.48 / $2,868.48 / $2,868.48
| Facility | AA | $2,868.48 | $2,868.48 | $2,868.48 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $561.00 / $696.62 / $896.40
| Facility | QK | $561.00 | $696.62 | $896.40 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $750.72 / $797.24 / $1,221.12
| Facility | QX | $750.72 | $797.24 | $1,221.12 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $1,086.83 / $1,086.83 / $1,086.83
| Facility | QY | $1,086.83 | $1,086.83 | $1,086.83 |
- Facility/Professional
- Facility
- Modifier
- QZ
- Low / Median / High Price
- $1,543.75 / $1,543.75 / $1,920.60
| Facility | QZ | $1,543.75 | $1,543.75 | $1,920.60 |