- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,606.93 / $7,943.28
| Professional | | $5,370.32 | $6,606.93 | $7,943.28 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $14,454.40
| Professional | | $10,964.78 | $10,964.78 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $6,165.95
| Facility | | $5,011.87 | $5,011.87 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $5,011.87 / $6,165.95
| Professional | | $891.25 | $5,011.87 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $5,623.41
| Facility | | $630.96 | $851.14 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,890.45 / $5,128.61
| Professional | | $2,398.83 | $3,890.45 | $5,128.61 |