- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.64 / $67.64 / $67.64
| Facility | | $67.64 | $67.64 | $67.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,373.22 / $1,373.22 / $1,373.22
| Facility | 50 | $1,373.22 | $1,373.22 | $1,373.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.72 / $330.00 / $339.05
| Facility | | $121.72 | $330.00 | $339.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.97 / $187.80 / $244.62
| Professional | | $143.97 | $187.80 | $244.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.58 / $37.00 / $114.89
| Facility | | $29.58 | $37.00 | $114.89 |