- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.77 / $2,158.73 / $2,510.71
| Facility | | $890.77 | $2,158.73 | $2,510.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.89 / $531.89 / $531.89
| Professional | | $531.89 | $531.89 | $531.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.89 / $531.89 / $760.60
| Facility | | $531.89 | $531.89 | $760.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.89 / $531.89 / $760.60
| Facility | | $531.89 | $531.89 | $760.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250,000.00 / $2,250,000.00 / $2,400,000.00
| Professional | | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |