- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.45 / $325.00 / $445.05
| Facility | | $223.45 | $325.00 | $445.05 |
- Facility/Professional
- Professional
- Modifier
- AA
- Low / Median / High Price
- $108.07 / $410.80 / $700.00
| Professional | AA | $108.07 | $410.80 | $700.00 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $255.00 / $255.00 / $306.00
| Professional | QZ | $255.00 | $255.00 | $306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.84 / $2,615.98 / $3,041.64
| Facility | | $42.84 | $2,615.98 | $3,041.64 |
- Facility/Professional
- Facility
- Modifier
- QK
- Low / Median / High Price
- $39.50 / $39.50 / $39.50
| Facility | QK | $39.50 | $39.50 | $39.50 |
- Facility/Professional
- Facility
- Modifier
- QX
- Low / Median / High Price
- $39.50 / $39.50 / $39.50
| Facility | QX | $39.50 | $39.50 | $39.50 |
- Facility/Professional
- Facility
- Modifier
- QY
- Low / Median / High Price
- $39.50 / $39.50 / $39.50
| Facility | QY | $39.50 | $39.50 | $39.50 |
- Facility/Professional
- Professional
- Modifier
- QZ
- Low / Median / High Price
- $293.25 / $293.25 / $351.90
| Professional | QZ | $293.25 | $293.25 | $351.90 |