- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $16.05 / $16.05
| Facility | | $16.05 | $16.05 | $16.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $16.05 / $20.66
| Professional | | $12.87 | $16.05 | $20.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.76 / $15.76 / $15.76
| Professional | | $15.76 | $15.76 | $15.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $17.35 / $27.53
| Professional | | $16.72 | $17.35 | $27.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.16 / $19.16 / $19.16
| Facility | | $19.16 | $19.16 | $19.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $18.92 / $32.31
| Professional | | $15.14 | $18.92 | $32.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.44 / $36.44 / $36.44
| Facility | | $36.44 | $36.44 | $36.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $22.84 / $34.18
| Professional | | $17.78 | $22.84 | $34.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.37 / $16.66 / $30.72
| Professional | | $14.37 | $16.66 | $30.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $24.97 / $34.10
| Professional | | $16.60 | $24.97 | $34.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.16 / $19.16 / $19.16
| Facility | | $19.16 | $19.16 | $19.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.08 / $18.92 / $31.55
| Professional | | $15.08 | $18.92 | $31.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.54 / $16.54 / $16.54
| Facility | | $16.54 | $16.54 | $16.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.12 / $16.54 / $17.22
| Professional | | $15.12 | $16.54 | $17.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $16.23 / $26.08
| Professional | | $12.89 | $16.23 | $26.08 |