- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.47 / $836.47 / $1,032.19
| Professional | | $836.47 | $836.47 | $1,032.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.74 / $360.74 / $360.74
| Professional | | $360.74 | $360.74 | $360.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.19 / $1,032.19 / $2,993.35
| Facility | | $1,032.19 | $1,032.19 | $2,993.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.19 / $1,032.19 / $2,993.35
| Facility | | $1,032.19 | $1,032.19 | $2,993.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.74 / $360.74 / $2,400,000.00
| Professional | | $360.74 | $360.74 | $2,400,000.00 |