- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.30 / $1,448.30 / $2,698.95
| Professional | | $1,448.30 | $1,448.30 | $2,698.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $198.37 / $198.37
| Professional | | $198.37 | $198.37 | $198.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.30 / $1,448.30 / $3,113.85
| Facility | | $1,448.30 | $1,448.30 | $3,113.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,448.30 / $1,448.30 / $3,113.85
| Facility | | $1,448.30 | $1,448.30 | $3,113.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $198.37 / $2,400,000.00
| Professional | | $198.37 | $198.37 | $2,400,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,706.55 / $2,849.00 / $2,849.00
| Professional | | $2,706.55 | $2,849.00 | $2,849.00 |