- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.52 / $28.52 / $41.51
| Professional | | $28.52 | $28.52 | $41.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.43 / $1,426.43 / $1,426.43
| Professional | | $1,426.43 | $1,426.43 | $1,426.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $70.00 / $1,500.00
| Professional | | $32.34 | $70.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.52 / $28.52 / $41.51
| Facility | | $28.52 | $28.52 | $41.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.43 / $2,250,000.00 / $2,400,000.00
| Professional | | $1,426.43 | $2,250,000.00 | $2,400,000.00 |