- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.58 / $16.60 / $19.80
| Facility | | $12.58 | $16.60 | $19.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.96 / $17.80 / $22.76
| Professional | | $14.96 | $17.80 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.63 / $20.32 / $29.10
| Professional | | $14.63 | $20.32 | $29.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.35 / $18.09 / $18.77
| Facility | | $16.35 | $18.09 | $18.77 |
- 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
- $17.04 / $22.33 / $36.53
| Professional | | $17.04 | $22.33 | $36.53 |
- 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
- Facility
- Modifier
- Low / Median / High Price
- $16.14 / $19.84 / $37.74
| Facility | | $16.14 | $19.84 | $37.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.50 / $24.39 / $31.29
| Professional | | $18.50 | $24.39 | $31.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.87 / $21.94 / $34.54
| Professional | | $16.87 | $21.94 | $34.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $20.05 / $38.04
| Facility | | $16.32 | $20.05 | $38.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.34 / $24.42 / $43.99
| Professional | | $17.34 | $24.42 | $43.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.43 / $19.32 / $30.24
| Professional | | $14.43 | $19.32 | $30.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $16.87 / $23.11
| Professional | | $14.36 | $16.87 | $23.11 |