- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,773.55 / $1,822.70 / $2,216.36
| Professional | | $1,773.55 | $1,822.70 | $2,216.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,349.75 / $2,349.75 / $2,937.19
| Professional | | $2,349.75 | $2,349.75 | $2,937.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.34 / $2,216.36 / $2,548.81
| Facility | | $1,792.34 | $2,216.36 | $2,548.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.78 / $1,872.78 / $1,872.78
| Professional | | $1,872.78 | $1,872.78 | $1,872.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.34 / $2,216.36 / $2,548.81
| Facility | | $1,792.34 | $2,216.36 | $2,548.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.78 / $1,800,000.00 / $2,400,000.00
| Professional | | $1,872.78 | $1,800,000.00 | $2,400,000.00 |