- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.74 / $52.74 / $73.89
| Facility | | $52.74 | $52.74 | $73.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $51.22 / $53.25
| Professional | | $50.72 | $51.22 | $53.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.72 / $50.72 / $50.72
| Professional | | $50.72 | $50.72 | $50.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.71 / $50.71 / $50.71
| Facility | | $50.71 | $50.71 | $50.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.71 / $50.71 / $50.71
| Professional | | $50.71 | $50.71 | $50.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.62 / $52.62 / $63.44
| Professional | | $52.62 | $52.62 | $63.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.18 / $50.72 / $54.83
| Professional | | $48.18 | $50.72 | $54.83 |