- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.57
| Facility | | $51.42 | $51.42 | $51.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.39 / $50.21 / $51.42
| Professional | | $48.39 | $50.21 | $51.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.40 / $50.40 / $50.40
| Professional | | $50.40 | $50.40 | $50.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.42
| Facility | | $51.42 | $51.42 | $51.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.42
| Professional | | $51.42 | $51.42 | $51.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.32 / $50.40 / $54.94
| Professional | | $40.32 | $50.40 | $54.94 |