- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.09 / $1,484.70 / $2,106.00
| Facility | | $452.09 | $1,484.70 | $2,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.18 / $314.18 / $314.18
| Professional | | $314.18 | $314.18 | $314.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.02 / $52.02 / $52.02
| Professional | | $52.02 | $52.02 | $52.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.18 / $314.18 / $449.28
| Facility | | $314.18 | $314.18 | $449.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.18 / $314.18 / $449.28
| Facility | | $314.18 | $314.18 | $449.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.02 / $52.02 / $2,250,000.00
| Professional | | $52.02 | $52.02 | $2,250,000.00 |