- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557,317.93 / $557,317.93 / $557,317.93
| Facility | | $557,317.93 | $557,317.93 | $557,317.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557,317.93 / $557,317.93 / $654,925.00
| Professional | | $557,317.93 | $557,317.93 | $654,925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528,312.38 / $528,312.38 / $660,390.47
| Professional | | $528,312.38 | $528,312.38 | $660,390.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691,338.73 / $889,933.03 / $1,442,850.00
| Facility | | $691,338.73 | $889,933.03 | $1,442,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557,317.93 / $557,317.93 / $557,317.93
| Professional | | $557,317.93 | $557,317.93 | $557,317.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526,228.26 / $554,003.59 / $568,323.47
| Facility | | $526,228.26 | $554,003.59 | $568,323.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526,228.26 / $554,728.05 / $792,468.64
| Professional | | $526,228.26 | $554,728.05 | $792,468.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609,895.10 / $609,895.10 / $609,895.10
| Professional | | $609,895.10 | $609,895.10 | $609,895.10 |