- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.33 / $1,401.33 / $1,401.33
| Professional | | $1,401.33 | $1,401.33 | $1,401.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,405.03 / $2,405.03 / $2,405.03
| Facility | | $2,405.03 | $2,405.03 | $2,405.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.65 / $196.76 / $240.32
| Professional | | $107.65 | $196.76 | $240.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.07 / $33.07 / $2,003.90
| Facility | | $33.07 | $33.07 | $2,003.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.16 / $69.16 / $98.80
| Professional | | $69.16 | $69.16 | $98.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.00 / $301.60 / $464.88
| Professional | | $260.00 | $301.60 | $464.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.07 / $39.68 / $2,405.03
| Facility | | $33.07 | $39.68 | $2,405.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.52 / $312.00 / $2,400,000.00
| Professional | | $43.52 | $312.00 | $2,400,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.51 / $1,197.06 / $2,473.75
| Professional | | $508.51 | $1,197.06 | $2,473.75 |