- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $112.68 / $241.71
| Professional | | $15.24 | $112.68 | $241.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $100.00 / $100.00
| Facility | | $90.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.39 / $108.39 / $108.39
| Professional | | $108.39 | $108.39 | $108.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $158.00 / $241.71
| Facility | | $15.24 | $158.00 | $241.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.68 / $158.00 / $241.71
| Facility | | $112.68 | $158.00 | $241.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $2,400,000.00 / $2,400,000.00
| Professional | | $10,000.00 | $2,400,000.00 | $2,400,000.00 |