- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.33 / $16.27 / $19.43
| Facility | | $12.33 | $16.27 | $19.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.47 / $17.00 / $22.22
| Professional | | $13.47 | $17.00 | $22.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.65 / $18.00 / $26.90
| Professional | | $14.65 | $18.00 | $26.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.03 / $17.43 / $18.09
| Facility | | $16.03 | $17.43 | $18.09 |
- 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
- $15.32 / $19.78 / $31.68
| Professional | | $15.32 | $19.78 | $31.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.59 / $84.08 / $105.00
| Facility | | $39.59 | $84.08 | $105.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.25 / $135.25 / $138.30
| Professional | | $135.25 | $135.25 | $138.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.27 / $18.27 / $31.38
| Facility | | $15.27 | $18.27 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $23.93 / $30.69
| Professional | | $18.14 | $23.93 | $30.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.55 / $21.16 / $33.26
| Professional | | $16.55 | $21.16 | $33.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.41 / $18.30 / $34.32
| Facility | | $15.41 | $18.30 | $34.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.86 / $21.67 / $42.46
| Professional | | $15.86 | $21.67 | $42.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.65 / $16.48 / $25.63
| Professional | | $12.65 | $16.48 | $25.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.02 / $16.54 / $22.67
| Professional | | $13.02 | $16.54 | $22.67 |