- 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
- $900.00 / $900.00 / $1,761.84
| Professional | | $900.00 | $900.00 | $1,761.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.08 / $342.08 / $455.81
| Facility | | $342.08 | $342.08 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.00 / $825.00 / $825.00
| Professional | | $825.00 | $825.00 | $825.00 |
- 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
- $900.00 / $1,761.84 / $2,400,000.00
| Professional | | $900.00 | $1,761.84 | $2,400,000.00 |