- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.41 / $530.41 / $530.41
| Professional | | $530.41 | $530.41 | $530.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.41 / $742.59 / $758.50
| Facility | | $530.41 | $742.59 | $758.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.65 / $404.65 / $578.08
| Professional | | $404.65 | $404.65 | $578.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,088.00 / $1,088.00 / $1,088.00
| Professional | | $1,088.00 | $1,088.00 | $1,088.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.41 / $742.59 / $758.50
| Facility | | $530.41 | $742.59 | $758.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.65 / $1,088.00 / $2,250,000.00
| Professional | | $404.65 | $1,088.00 | $2,250,000.00 |