- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541,636.00 / $541,636.00 / $622,881.00
| Facility | | $541,636.00 | $541,636.00 | $622,881.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541,636.00 / $579,414.32 / $703,172.73
| Professional | | $541,636.00 | $579,414.32 | $703,172.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562,538.18 / $703,172.73 / $984,441.83
| Facility | | $562,538.18 | $703,172.73 | $984,441.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562,538.18 / $675,045.83 / $703,172.74
| Professional | | $562,538.18 | $675,045.83 | $703,172.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $800,485.56 / $1,007,062.50
| Professional | | $30.00 | $800,485.56 | $1,007,062.50 |