- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.83 / $124.83 / $124.83
| Facility | | $124.83 | $124.83 | $124.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.83 / $128.72 / $171.51
| Professional | | $124.83 | $128.72 | $171.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $1,500.00
| Professional | | $50.00 | $60.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.42 / $149.43 / $183.30
| Facility | | $109.42 | $149.43 | $183.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.00 / $2,250,000.00 / $2,250,000.00
| Professional | | $600.00 | $2,250,000.00 | $2,250,000.00 |