- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,313.19 / $3,139.35 / $3,494.22
| Professional | | $2,313.19 | $3,139.35 | $3,494.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.81 / $841.19 / $1,317.63
| Facility | | $678.81 | $841.19 | $1,317.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.06 / $678.81 / $995.71
| Professional | | $506.06 | $678.81 | $995.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $668.85 / $926.84 / $2,917.27
| Facility | | $668.85 | $926.84 | $2,917.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.72 / $678.81 / $2,400,000.00
| Professional | | $85.72 | $678.81 | $2,400,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.54 / $1,681.78 / $2,953.51
| Professional | | $598.54 | $1,681.78 | $2,953.51 |