- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $318.75 / $318.75
| Professional | | $318.75 | $318.75 | $318.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,338.15 / $1,338.15
| Professional | | $1,338.15 | $1,338.15 | $1,338.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.28 / $397.28 / $455.81
| Facility | | $397.28 | $397.28 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,390.00 / $1,390.00 / $1,390.00
| Professional | | $1,390.00 | $1,390.00 | $1,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.75 / $436.69 / $455.81
| Facility | | $318.75 | $436.69 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,338.15 / $1,800,000.00 / $2,400,000.00
| Professional | | $1,338.15 | $1,800,000.00 | $2,400,000.00 |