- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.71 / $242.71 / $242.71
| Professional | | $242.71 | $242.71 | $242.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.04 / $116.04 / $116.04
| Professional | | $116.04 | $116.04 | $116.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.71 / $242.71 / $703.86
| Facility | | $242.71 | $242.71 | $703.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.71 / $242.71 / $703.86
| Facility | | $242.71 | $242.71 | $703.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.04 / $116.04 / $2,400,000.00
| Professional | | $116.04 | $116.04 | $2,400,000.00 |