- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.80 / $19.80 / $19.80
| Facility | | $17.80 | $19.80 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.41 / $18.27 / $25.17
| Professional | | $16.41 | $18.27 | $25.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.12 / $26.12 / $118.21
| Facility | | $26.12 | $26.12 | $118.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.80 / $26.00 / $48.57
| Professional | | $18.80 | $26.00 | $48.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.55 / $22.74 / $52.61
| Professional | | $15.55 | $22.74 | $52.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.97 / $19.97 / $19.97
| Facility | | $19.97 | $19.97 | $19.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.53 / $24.27 / $47.67
| Professional | | $18.53 | $24.27 | $47.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.70 / $19.48 / $26.31
| Professional | | $16.70 | $19.48 | $26.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $19.96 / $64.00
| Professional | | $16.00 | $19.96 | $64.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.47 / $85.69 / $105.00
| Facility | | $40.47 | $85.69 | $105.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.30 / $162.30 / $162.30
| Professional | | $162.30 | $162.30 | $162.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.14 / $21.56 / $31.22
| Facility | | $17.14 | $21.56 | $31.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $26.40 / $46.72
| Professional | | $18.73 | $26.40 | $46.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.44 / $58.44 / $58.44
| Professional | | $58.44 | $58.44 | $58.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.98 / $19.30 / $39.11
| Professional | | $13.98 | $19.30 | $39.11 |