- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.56 / $233.56 / $233.56
| Facility | | $233.56 | $233.56 | $233.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.56 / $233.56 / $2,234.60
| Professional | | $233.56 | $233.56 | $2,234.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $85.00
| Professional | | $60.00 | $60.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.56 / $2,234.60 / $2,234.60
| Facility | | $233.56 | $2,234.60 | $2,234.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,400,000.00 / $2,400,000.00 / $2,400,000.00
| Professional | | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 |