- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.60 / $902.58 / $2,116.48
| Facility | | $96.60 | $902.58 | $2,116.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.59 / $44.59 / $44.59
| Professional | | $44.59 | $44.59 | $44.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.67 / $343.67 / $343.67
| Professional | | $343.67 | $343.67 | $343.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.59 / $62.43 / $129.31
| Facility | | $44.59 | $62.43 | $129.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.59 / $62.43 / $129.31
| Facility | | $44.59 | $62.43 | $129.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.67 / $343.67 / $2,400,000.00
| Professional | | $343.67 | $343.67 | $2,400,000.00 |