- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.76 / $1,096.13 / $1,451.72
| Professional | | $890.76 | $1,096.13 | $1,451.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,489.30 / $1,530.08 / $2,841.68
| Facility | | $1,489.30 | $1,530.08 | $2,841.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $994.55 / $1,377.07 / $4,662.95
| Professional | | $994.55 | $1,377.07 | $4,662.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $864.21 / $1,264.70 / $1,979.78
| Facility | | $864.21 | $1,264.70 | $1,979.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,015.79 / $1,530.08 / $2,400,000.00
| Professional | | $1,015.79 | $1,530.08 | $2,400,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.85 / $2,781.31 / $3,310.16
| Professional | | $1,555.85 | $2,781.31 | $3,310.16 |