- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.06 / $1,371.90 / $1,371.90
| Facility | | $1,145.06 | $1,371.90 | $1,371.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.54 / $1,145.06 / $1,145.06
| Professional | | $773.54 | $1,145.06 | $1,145.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $976.75 / $3,403.14 / $5,836.11
| Facility | | $976.75 | $3,403.14 | $5,836.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.86 / $520.86 / $520.86
| Professional | | $520.86 | $520.86 | $520.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $85.00
| Professional | | $60.00 | $60.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.39 / $1,145.06 / $1,488.58
| Facility | | $81.39 | $1,145.06 | $1,488.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.86 / $520.86 / $2,250,000.00
| Professional | | $520.86 | $520.86 | $2,250,000.00 |