- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $4,786.30 / $5,754.40
| Professional | | $3,890.45 | $4,786.30 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151,356.12 / $151,356.12 / $1,000,000.00
| Facility | | $151,356.12 | $151,356.12 | $1,000,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $4,466.84
| Facility | | $3,090.30 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $3,090.30 / $4,466.84
| Professional | | $645.65 | $3,090.30 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $616.60 / $4,073.80
| Facility | | $457.09 | $616.60 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,818.38 / $3,715.35
| Professional | | $1,737.80 | $2,818.38 | $3,715.35 |