- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541,260.00 / $541,260.00 / $622,450.00
| Facility | | $541,260.00 | $541,260.00 | $622,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541,260.00 / $613,049.73 / $696,647.42
| Professional | | $541,260.00 | $613,049.73 | $696,647.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613,049.73 / $738,446.27 / $996,205.81
| Facility | | $613,049.73 | $738,446.27 | $996,205.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557,317.93 / $613,049.72 / $696,647.41
| Professional | | $557,317.93 | $613,049.72 | $696,647.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527,622.43 / $527,622.43 / $527,622.43
| Professional | | $527,622.43 | $527,622.43 | $527,622.43 |