- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.38 / $147.72 / $147.72
| Professional | | $142.38 | $147.72 | $147.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.16 / $146.16 / $151.27
| Facility | | $146.16 | $146.16 | $151.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.16 / $146.16 / $151.27
| Professional | | $146.16 | $146.16 | $151.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.38 / $177.97 / $202.24
| Facility | | $142.38 | $177.97 | $202.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.16 / $151.27 / $1,800,000.00
| Professional | | $146.16 | $151.27 | $1,800,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.79 / $161.79 / $161.79
| Professional | | $161.79 | $161.79 | $161.79 |