- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,124.68 / $7,124.68 / $7,124.68
| Facility | | $7,124.68 | $7,124.68 | $7,124.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,024.61 / $7,961.62 / $9,378.75
| Professional | | $6,024.61 | $7,961.62 | $9,378.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,961.62 / $8,359.70 / $10,907.42
| Facility | | $7,961.62 | $8,359.70 | $10,907.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79,999.20 / $79,999.20 / $79,999.20
| Facility | | $79,999.20 | $79,999.20 | $79,999.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,961.62 / $7,961.62 / $11,385.12
| Facility | | $7,961.62 | $7,961.62 | $11,385.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,250,000.00 / $2,250,000.00 / $2,400,000.00
| Professional | | $2,250,000.00 | $2,250,000.00 | $2,400,000.00 |