- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $3,090.30 / $5,128.61
| Facility | | $346.74 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | 50 | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $562.34 / $3,630.78
| Professional | 50 | $407.38 | $562.34 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,630.78 / $45,708.82
| Facility | | $954.99 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $1,096.48
| Facility | | $478.63 | $478.63 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $794.33 / $7,079.46
| Facility | | $363.08 | $794.33 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,630.78 / $45,708.82
| Facility | | $1,000.00 | $3,630.78 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |