- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.71 / $248.71 / $248.71
| Facility | | $248.71 | $248.71 | $248.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.71 / $248.71 / $1,040.33
| Professional | | $248.71 | $248.71 | $1,040.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.08 / $404.08 / $404.08
| Facility | | $404.08 | $404.08 | $404.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.56 / $324.56 / $324.56
| Professional | | $324.56 | $324.56 | $324.56 |
- 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
- $248.71 / $248.71 / $1,040.33
| Facility | | $248.71 | $248.71 | $1,040.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.56 / $2,250,000.00 / $2,400,000.00
| Professional | | $324.56 | $2,250,000.00 | $2,400,000.00 |