- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $1,412.54
| Facility | | $19.05 | $19.05 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $24.55
| Facility | | $20.42 | $20.42 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Facility | | $32.36 | $32.36 | $32.36 |
- 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
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $2,511.89
| Facility | | $1,230.27 | $1,230.27 | $2,511.89 |