- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.72 / $50.72 / $52.24
| Facility | | $50.72 | $50.72 | $52.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $50.72 / $53.25
| Professional | | $50.72 | $50.72 | $53.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.26 / $50.72 / $89.15
| Facility | | $44.26 | $50.72 | $89.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $50.72 / $51.22
| Professional | | $50.72 | $50.72 | $51.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.27 / $50.71 / $50.71
| Facility | | $49.27 | $50.71 | $50.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.71 / $50.71 / $59.81
| Professional | | $50.71 | $50.71 | $59.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $50.72 / $60.86
| Professional | | $50.72 | $50.72 | $60.86 |