- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Professional | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $991.78 / $991.78 / $991.78
| Facility | | $991.78 | $991.78 | $991.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.02 / $541.02 / $541.02
| Facility | | $541.02 | $541.02 | $541.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.02 / $541.02 / $541.02
| Facility | | $541.02 | $541.02 | $541.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,400,000.00 / $2,400,000.00 / $2,400,000.00
| Professional | | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 |