- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.77 / $133.77 / $133.77
| Facility | | $133.77 | $133.77 | $133.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.77 / $146.19 / $152.94
| Professional | | $133.77 | $146.19 | $152.94 |
- 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
- $77.98 / $121.53 / $171.42
| Facility | | $77.98 | $121.53 | $171.42 |
- 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 |