- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.50 / $251.01 / $1,641.16
| Facility | | $20.50 | $251.01 | $1,641.16 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $500.49 / $959.26 / $2,536.84
| Facility | 25 | $500.49 | $959.26 | $2,536.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.13 / $31.13 / $1,007.00
| Facility | | $31.13 | $31.13 | $1,007.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.19 / $13.19 / $1,973.00
| Facility | | $13.19 | $13.19 | $1,973.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.55 / $32.00 / $37.20
| Facility | | $17.55 | $32.00 | $37.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.19 / $13.19 / $1,973.00
| Facility | | $13.19 | $13.19 | $1,973.00 |