- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,569.00 / $10,569.00 / $10,569.00
| Facility | | $10,569.00 | $10,569.00 | $10,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,874.59 / $7,874.59 / $10,569.00
| Professional | | $7,874.59 | $7,874.59 | $10,569.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,100.47 / $7,100.47 / $7,100.47
| Facility | | $7,100.47 | $7,100.47 | $7,100.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,035.40 / $7,100.47 / $7,100.47
| Professional | | $6,035.40 | $7,100.47 | $7,100.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,470.60 / $7,874.59 / $10,788.19
| Facility | | $5,470.60 | $7,874.59 | $10,788.19 |
- 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
- $5,470.60 / $7,874.59 / $2,700,000.00
| Facility | | $5,470.60 | $7,874.59 | $2,700,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,035.40 / $7,100.47 / $2,400,000.00
| Professional | | $6,035.40 | $7,100.47 | $2,400,000.00 |