- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.57 / $87.93 / $117.82
| Professional | | $35.57 | $87.93 | $117.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.33 / $149.33 / $149.33
| Facility | | $149.33 | $149.33 | $149.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.08 / $78.08 / $149.33
| Professional | | $78.08 | $78.08 | $149.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.28 / $117.82 / $174.57
| Facility | | $86.28 | $117.82 | $174.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.08 / $149.33 / $2,250,000.00
| Professional | | $78.08 | $149.33 | $2,250,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.15 / $161.40 / $190.27
| Professional | | $139.15 | $161.40 | $190.27 |