- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.51 / $677.33 / $835.64
| Professional | | $668.51 | $677.33 | $835.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,102.50 / $4,472.96 / $13,687.50
| Facility | | $3,102.50 | $4,472.96 | $13,687.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,212.50 / $10,037.50 / $16,425.00
| Professional | | $8,212.50 | $10,037.50 | $16,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.03 / $1,114.42 / $2,522.36
| Professional | | $912.03 | $1,114.42 | $2,522.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,650.00 / $3,650.00 / $4,562.50
| Facility | | $3,650.00 | $3,650.00 | $4,562.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,380.00 / $4,562.50 / $2,250,000.00
| Professional | | $4,380.00 | $4,562.50 | $2,250,000.00 |