- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $54.54
| Professional | | $34.67 | $34.67 | $54.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $8.96 / $24.26
| Professional | | $8.96 | $8.96 | $24.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,495.87 / $3,495.87 / $3,495.87
| Facility | | $3,495.87 | $3,495.87 | $3,495.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,495.87 / $3,495.87 / $3,495.87
| Facility | | $3,495.87 | $3,495.87 | $3,495.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $8.96 / $2,250,000.00
| Professional | | $8.96 | $8.96 | $2,250,000.00 |