- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.61 / $38.52 / $44.02
| Facility | | $37.61 | $38.52 | $44.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $38.52 / $49.53
| Professional | | $36.69 | $38.52 | $49.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.78 / $36.69 / $36.69
| Facility | | $13.78 | $36.69 | $36.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.69 / $36.69 / $36.69
| Professional | | $36.69 | $36.69 | $36.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.22 / $36.69 / $47.70
| Professional | | $35.22 | $36.69 | $47.70 |