- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.39 / $16.39 / $16.39
| Facility | | $16.39 | $16.39 | $16.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $16.39 / $20.26
| Professional | | $13.36 | $16.39 | $20.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $17.70 / $28.19
| Professional | | $17.05 | $17.70 | $28.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.55 / $19.55 / $19.55
| Facility | | $19.55 | $19.55 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.55 / $19.30 / $33.04
| Professional | | $15.55 | $19.30 | $33.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.16 / $23.32 / $34.89
| Professional | | $18.16 | $23.32 | $34.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.67 / $17.00 / $31.38
| Professional | | $14.67 | $17.00 | $31.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $16.89
| Facility | | $16.89 | $16.89 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $25.46 / $34.79
| Professional | | $16.89 | $25.46 | $34.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.55 / $19.55 / $19.55
| Facility | | $19.55 | $19.55 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.42 / $19.30 / $32.17
| Professional | | $15.42 | $19.30 | $32.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.88 / $16.88 / $16.88
| Facility | | $16.88 | $16.88 | $16.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.81 / $16.88 / $17.55
| Professional | | $15.81 | $16.88 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.53 / $16.86 / $27.53
| Professional | | $13.53 | $16.86 | $27.53 |