- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,344.60 / $1,344.60
| Professional | | $1,296.00 | $1,344.60 | $1,344.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,377.00 / $1,818.74 / $1,818.74
| Facility | | $1,377.00 | $1,818.74 | $1,818.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.00 / $1,818.74 / $1,818.74
| Professional | | $1,377.00 | $1,818.74 | $1,818.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,620.00 / $1,818.74
| Facility | | $1,296.00 | $1,620.00 | $1,818.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.00 / $1,818.74 / $2,250,000.00
| Professional | | $1,377.00 | $1,818.74 | $2,250,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.00 / $1,350.00 / $1,350.00
| Professional | | $1,350.00 | $1,350.00 | $1,350.00 |