- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148,153.62 / $1,148,153.62 / $1,148,153.62
| Facility | | $1,148,153.62 | $1,148,153.62 | $1,148,153.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $616,595.00
| Professional | | $588,843.66 | $588,843.66 | $616,595.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $616,595.00
| Facility | | $588,843.66 | $588,843.66 | $616,595.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588,843.66 / $588,843.66 / $588,843.66
| Professional | | $588,843.66 | $588,843.66 | $588,843.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87,096.36 / $87,096.36 / $87,096.36
| Professional | | $87,096.36 | $87,096.36 | $87,096.36 |