- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.66 / $196.66 / $196.66
| Professional | | $196.66 | $196.66 | $196.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.66 / $275.32 / $281.22
| Facility | | $196.66 | $275.32 | $281.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.60 / $159.60 / $228.00
| Professional | | $159.60 | $159.60 | $228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.00 / $638.00 / $638.00
| Professional | | $630.00 | $638.00 | $638.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.66 / $275.32 / $281.22
| Facility | | $196.66 | $275.32 | $281.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.60 / $638.00 / $2,250,000.00
| Professional | | $159.60 | $638.00 | $2,250,000.00 |