- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.41 / $791.41 / $791.41
| Professional | | $791.41 | $791.41 | $791.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.26 / $271.26 / $271.26
| Professional | | $271.26 | $271.26 | $271.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.41 / $791.41 / $1,131.72
| Facility | | $791.41 | $791.41 | $1,131.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $791.41 / $791.41 / $1,131.72
| Facility | | $791.41 | $791.41 | $1,131.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.26 / $2,250,000.00 / $2,400,000.00
| Professional | | $271.26 | $2,250,000.00 | $2,400,000.00 |