- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489,720.00 / $489,720.00 / $563,178.00
| Facility | | $489,720.00 | $489,720.00 | $563,178.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489,304.61 / $503,983.75 / $611,630.76
| Professional | | $489,304.61 | $503,983.75 | $611,630.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489,304.61 / $611,630.76 / $856,283.07
| Facility | | $489,304.61 | $611,630.76 | $856,283.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489,304.61 / $587,165.53 / $611,630.76
| Professional | | $489,304.61 | $587,165.53 | $611,630.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $489,399.16 / $954,328.40
| Professional | | $30.00 | $489,399.16 | $954,328.40 |