- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.73 / $114.73 / $114.73
| Professional | | $114.73 | $114.73 | $114.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $1.62 / $1.62
| Professional | | $1.62 | $1.62 | $1.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.73 / $114.73 / $332.72
| Facility | | $114.73 | $114.73 | $332.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.73 / $114.73 / $332.72
| Facility | | $114.73 | $114.73 | $332.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $1.62 / $1,800,000.00
| Professional | | $1.62 | $1.62 | $1,800,000.00 |