- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.15 / $33.15 / $33.15
| Facility | | $33.15 | $33.15 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $47.90 / $53.50
| Professional | | $33.15 | $47.90 | $53.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.83 / $60.00 / $1,000.00
| Professional | | $38.83 | $60.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.57 / $47.68 / $62.35
| Facility | | $32.57 | $47.68 | $62.35 |
- 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 |