- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.06 / $540.24 / $540.24
| Professional | | $317.06 | $540.24 | $540.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.69 / $540.24 / $756.34
| Facility | | $509.69 | $540.24 | $756.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.50 / $465.50 / $665.00
| Professional | | $465.50 | $465.50 | $665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.00 / $1,377.00 / $1,518.00
| Professional | | $1,289.00 | $1,377.00 | $1,518.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.85 / $540.24 / $756.34
| Facility | | $384.85 | $540.24 | $756.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.00 / $1,377.00 / $2,250,000.00
| Professional | | $665.00 | $1,377.00 | $2,250,000.00 |