- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.79 / $161.79 / $161.79
| Facility | | $161.79 | $161.79 | $161.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.79 / $178.06 / $179.52
| Professional | | $161.79 | $178.06 | $179.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $70.00 / $1,500.00
| Professional | | $45.00 | $70.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.21 / $159.87 / $208.85
| Facility | | $151.21 | $159.87 | $208.85 |
- 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 |