- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.27 / $1,609.27 / $1,609.27
| Facility | | $1,609.27 | $1,609.27 | $1,609.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.27 / $1,609.27 / $1,609.27
| Professional | | $1,609.27 | $1,609.27 | $1,609.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $100.00 / $100.00
| Facility | | $80.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.27 / $1,609.27 / $4,000.00
| Facility | | $1,609.27 | $1,609.27 | $4,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.27 / $1,609.27 / $1,609.27
| Professional | | $1,609.27 | $1,609.27 | $1,609.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.27 / $1,609.27 / $3,411.65
| Facility | | $1,609.27 | $1,609.27 | $3,411.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.27 / $2,250,000.00 / $2,400,000.00
| Professional | | $1,609.27 | $2,250,000.00 | $2,400,000.00 |