- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.72 / $16.72 / $16.72
| Facility | | $16.72 | $16.72 | $16.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.43 / $17.19 / $21.50
| Professional | | $15.43 | $17.19 | $21.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.41 / $18.05 / $32.65
| Professional | | $17.41 | $18.05 | $32.65 |
- 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
- $16.42 / $22.16 / $37.10
| Professional | | $16.42 | $22.16 | $37.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.86 / $37.86 / $37.86
| Facility | | $37.86 | $37.86 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $23.78 / $35.59
| Professional | | $19.73 | $23.78 | $35.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.94 / $17.94 / $32.03
| Professional | | $15.94 | $17.94 | $32.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.90 / $21.90 / $21.90
| Facility | | $21.90 | $21.90 | $21.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.90 / $25.84 / $36.50
| Professional | | $21.90 | $25.84 | $36.50 |
- 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
- $16.39 / $22.14 / $36.65
| Professional | | $16.39 | $22.14 | $36.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.22 / $17.22 / $17.22
| Facility | | $17.22 | $17.22 | $17.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $17.22 / $19.82
| Professional | | $16.78 | $17.22 | $19.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.35 / $18.96 / $32.15
| Professional | | $15.35 | $18.96 | $32.15 |