- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.43 / $309.43 / $309.43
| Facility | | $309.43 | $309.43 | $309.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.10 / $309.43 / $500.98
| Professional | | $300.10 | $309.43 | $500.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $433.23 / $1,500.00
| Professional | | $70.00 | $433.23 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.08 / $513.36 / $640.54
| Facility | | $318.08 | $513.36 | $640.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,400,000.00 / $2,400,000.00 / $2,400,000.00
| Professional | | $2,400,000.00 | $2,400,000.00 | $2,400,000.00 |