- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,932.50 / $6,932.50 / $6,932.50
| Facility | | $6,932.50 | $6,932.50 | $6,932.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,932.50 / $6,932.50 / $6,932.50
| Professional | | $6,932.50 | $6,932.50 | $6,932.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,932.50 / $6,932.50 / $9,497.53
| Facility | | $6,932.50 | $6,932.50 | $9,497.53 |
- 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
- $6,932.50 / $6,932.50 / $2,700,000.00
| Facility | | $6,932.50 | $6,932.50 | $2,700,000.00 |
- 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 |