- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.00 / $915.68 / $1,011.61
| Professional | | $500.00 | $915.68 | $1,011.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.08 / $872.08 / $872.08
| Facility | | $872.08 | $872.08 | $872.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.08 / $946.13 / $995.49
| Professional | | $872.08 | $946.13 | $995.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.72 / $872.08 / $872.08
| Facility | | $354.72 | $872.08 | $872.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.08 / $946.13 / $2,250,000.00
| Professional | | $872.08 | $946.13 | $2,250,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.08 / $872.08 / $872.08
| Professional | | $872.08 | $872.08 | $872.08 |