- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $241.71 / $241.71
| Professional | | $15.24 | $241.71 | $241.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.45 / $449.45 / $449.45
| Professional | | $449.45 | $449.45 | $449.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $241.71 / $241.71
| Facility | | $15.24 | $241.71 | $241.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $112.68 / $241.71
| Facility | | $15.24 | $112.68 | $241.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250,000.00 / $2,400,000.00 / $2,400,000.00
| Professional | | $2,250,000.00 | $2,400,000.00 | $2,400,000.00 |