- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $14.15 / $14.15
| Professional | | $13.64 | $14.15 | $14.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $19.47
| Facility | | $17.05 | $17.05 | $19.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $19.47
| Professional | | $17.05 | $17.05 | $19.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.64 / $17.05 / $17.05
| Facility | | $13.64 | $17.05 | $17.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $18.50 / $2,400,000.00
| Professional | | $17.05 | $18.50 | $2,400,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $17.05 / $17.05
| Professional | | $17.05 | $17.05 | $17.05 |