- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.15 / $48.92 / $136.41
| Professional | | $47.15 | $48.92 | $136.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.09 / $88.51 / $155.41
| Facility | | $78.09 | $88.51 | $155.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.07 / $52.07 / $58.94
| Professional | | $52.07 | $52.07 | $58.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.92 / $52.07 / $106.74
| Facility | | $48.92 | $52.07 | $106.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.07 / $56.49 / $2,250,000.00
| Professional | | $52.07 | $56.49 | $2,250,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.94 / $58.94 / $58.94
| Professional | | $58.94 | $58.94 | $58.94 |