- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.04 / $1,227.04 / $1,227.04
| Facility | | $1,227.04 | $1,227.04 | $1,227.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.04 / $1,227.04 / $1,507.00
| Professional | | $1,227.04 | $1,227.04 | $1,507.00 |
- 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
- $1,227.04 / $1,227.04 / $1,595.15
| Facility | | $1,227.04 | $1,227.04 | $1,595.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250,000.00 / $2,250,000.00 / $2,400,000.00
| Professional | | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |