- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,549.93 / $11,220.18
| Professional | | $7,585.78 | $9,549.93 | $11,220.18 |
- 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
- $15,848.93 / $15,848.93 / $20,892.96
| Professional | | $15,848.93 | $15,848.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $11,220.18 / $11,220.18
| Facility | | $8,709.64 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $11,220.18 / $11,220.18
| Professional | | $1,288.25 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,230.27 / $8,128.31
| Facility | | $912.01 | $1,230.27 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,623.41 / $7,413.10
| Professional | | $3,388.44 | $5,623.41 | $7,413.10 |