- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,238.72
| Professional | AA | $1,174.90 | $1,548.82 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $416.87 / $416.87 / $1,737.80
| Professional | QZ | $416.87 | $416.87 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $39.81 / $39.81 / $52.48
| Facility | QK | $39.81 | $39.81 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $39.81 / $39.81 / $52.48
| Facility | QX | $39.81 | $39.81 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $39.81 / $39.81 / $52.48
| Facility | QY | $39.81 | $39.81 | $52.48 |