- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $404.13 / $404.13 / $439.79
| Professional | | $404.13 | $404.13 | $439.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.51 / $104.51 / $104.51
| Professional | | $104.51 | $104.51 | $104.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $60.00 / $1,500.00
| Professional | | $32.34 | $60.00 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.48 / $404.13 / $1,055.09
| Facility | | $234.48 | $404.13 | $1,055.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.51 / $104.51 / $2,250,000.00
| Professional | | $104.51 | $104.51 | $2,250,000.00 |