- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.13 / $387.41 / $387.41
| Professional | | $203.13 | $387.41 | $387.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.41 / $542.37 / $554.00
| Facility | | $387.41 | $542.37 | $554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.57 / $171.57 / $245.10
| Professional | | $171.57 | $171.57 | $245.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.00 / $574.00 / $623.00
| Professional | | $562.00 | $574.00 | $623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.41 / $542.37 / $554.00
| Facility | | $387.41 | $542.37 | $554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.57 / $574.00 / $2,250,000.00
| Professional | | $171.57 | $574.00 | $2,250,000.00 |