- 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
- $1,125.00 / $1,190.00 / $1,471.54
| Professional | | $1,125.00 | $1,190.00 | $1,471.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $455.81
| Facility | | $425.00 | $425.00 | $455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,834.00 / $1,834.00 / $1,834.00
| Professional | | $1,834.00 | $1,834.00 | $1,834.00 |
- 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
- $1,125.00 / $1,471.54 / $2,400,000.00
| Professional | | $1,125.00 | $1,471.54 | $2,400,000.00 |