- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489,304.61 / $1,527,930.00 / $1,860,940.00
| Facility | | $489,304.61 | $1,527,930.00 | $1,860,940.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489,304.61 / $489,304.61 / $494,197.65
| Professional | | $489,304.61 | $489,304.61 | $494,197.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614,800.00 / $699,600.00 / $1,454,320.00
| Professional | | $614,800.00 | $699,600.00 | $1,454,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489,720.00 / $489,720.00 / $586,740.00
| Professional | | $489,720.00 | $489,720.00 | $586,740.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415,908.92 / $443,520.00 / $498,960.00
| Professional | | $415,908.92 | $443,520.00 | $498,960.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89,304.61 / $89,304.61 / $89,304.61
| Professional | | $89,304.61 | $89,304.61 | $89,304.61 |