- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $730.60 / $730.60 / $1,580.96
| Professional | AA | $730.60 | $730.60 | $1,580.96 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $962.00 / $962.00 / $962.00
| Professional | AA | $962.00 | $962.00 | $962.00 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $37.00 / $37.00 / $39.50
| Facility | QK | $37.00 | $37.00 | $39.50 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $37.00 / $37.00 / $39.50
| Facility | QX | $37.00 | $37.00 | $39.50 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $37.00 / $37.00 / $39.50
| Facility | QY | $37.00 | $37.00 | $39.50 |