- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621,312.51 / $621,312.51 / $621,312.51
| Facility | | $621,312.51 | $621,312.51 | $621,312.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502,967.27 / $591,726.19 / $621,312.51
| Professional | | $502,967.27 | $591,726.19 | $621,312.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591,726.19 / $627,762.32 / $809,185.58
| Professional | | $591,726.19 | $627,762.32 | $809,185.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.81 / $518,262.49 / $620,937.13
| Professional | | $2.81 | $518,262.49 | $620,937.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502,967.27 / $628,709.09 / $1,099,723.13
| Facility | | $502,967.27 | $628,709.09 | $1,099,723.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $672,074.93 / $672,074.93 / $672,074.93
| Professional | | $672,074.93 | $672,074.93 | $672,074.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591,726.19 / $591,726.19 / $591,726.19
| Facility | | $591,726.19 | $591,726.19 | $591,726.19 |