- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $2,691.53 / $4,365.16
| Facility | | $30.90 | $2,691.53 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $812.83 / $1,862.09
| Facility | | $380.19 | $812.83 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $489.78
| Facility | | $16.22 | $16.22 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $537.03 / $741.31
| Facility | | $32.36 | $537.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Facility | 52 | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,318.26 / $3,388.44
| Facility | | $467.74 | $1,318.26 | $3,388.44 |