- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.17 / $22.29 / $25.30
| Facility | | $17.17 | $22.29 | $25.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.17 / $22.59 / $30.12
| Professional | | $17.17 | $22.59 | $30.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.10 / $19.64 / $21.97
| Facility | | $18.10 | $19.64 | $21.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.37 / $18.37 / $18.37
| Professional | | $18.37 | $18.37 | $18.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.40 / $34.40 / $34.40
| Facility | | $34.40 | $34.40 | $34.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.66 / $20.66 / $22.99
| Facility | | $20.66 | $20.66 | $22.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $17.55 / $24.31
| Professional | | $17.55 | $17.55 | $24.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.55 / $163.40 / $163.40
| Facility | | $161.55 | $163.40 | $163.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.31 / $171.31 / $258.00
| Professional | | $171.31 | $171.31 | $258.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.42 / $25.30 / $34.40
| Facility | | $9.42 | $25.30 | $34.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $30.96 / $34.40
| Professional | | $21.05 | $30.96 | $34.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.42 / $24.62 / $34.40
| Facility | | $9.42 | $24.62 | $34.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $17.55 / $28.60
| Professional | | $17.55 | $17.55 | $28.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.16 / $15.86 / $20.93
| Professional | | $12.16 | $15.86 | $20.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $17.23 / $34.40
| Professional | | $17.23 | $17.23 | $34.40 |