- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.44 / $27.84 / $31.60
| Facility | | $21.44 | $27.84 | $31.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $28.22 / $37.61
| Professional | | $21.44 | $28.22 | $37.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.60 / $24.54 / $27.45
| Facility | | $22.60 | $24.54 | $27.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.95 / $22.95 / $22.95
| Professional | | $22.95 | $22.95 | $22.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.96 / $42.96 / $42.96
| Facility | | $42.96 | $42.96 | $42.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.81 / $25.81 / $27.98
| Facility | | $25.81 | $25.81 | $27.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $21.94 / $30.36
| Professional | | $21.94 | $21.94 | $30.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.75 / $204.06 / $204.06
| Facility | | $201.75 | $204.06 | $204.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.94 / $213.94 / $322.20
| Professional | | $213.94 | $213.94 | $322.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $31.60 / $42.96
| Facility | | $11.76 | $31.60 | $42.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.29 / $38.65 / $42.96
| Professional | | $26.29 | $38.65 | $42.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $30.75 / $42.96
| Facility | | $11.76 | $30.75 | $42.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $21.94 / $35.72
| Professional | | $21.94 | $21.94 | $35.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.18 / $19.82 / $26.14
| Professional | | $15.18 | $19.82 | $26.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.53 / $21.53 / $42.96
| Professional | | $21.53 | $21.53 | $42.96 |