- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.58 / $590.58 / $590.58
| Professional | | $590.58 | $590.58 | $590.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.58 / $826.81 / $844.53
| Facility | | $590.58 | $826.81 | $844.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.19 / $588.19 / $840.28
| Professional | | $588.19 | $588.19 | $840.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,076.00 / $3,114.00 / $3,114.00
| Professional | | $3,076.00 | $3,114.00 | $3,114.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.58 / $826.81 / $844.53
| Facility | | $590.58 | $826.81 | $844.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.19 / $3,114.00 / $2,250,000.00
| Professional | | $588.19 | $3,114.00 | $2,250,000.00 |