- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.20 / $17.53 / $17.87
| Facility | | $17.20 | $17.53 | $17.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.25 / $17.87 / $29.00
| Professional | | $16.25 | $17.87 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $18.32 / $18.32
| Professional | | $18.32 | $18.32 | $18.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.50 / $38.50 / $38.50
| Facility | | $38.50 | $38.50 | $38.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $21.38
| Professional | | $15.61 | $15.61 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $178.31 / $178.31
| Facility | | $80.00 | $178.31 | $178.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.88 / $192.88 / $280.20
| Professional | | $192.88 | $192.88 | $280.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $25.73 / $38.50
| Facility | | $11.02 | $25.73 | $38.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $34.65 / $38.50
| Professional | | $11.02 | $34.65 | $38.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.45 / $38.50 / $88.36
| Professional | | $29.45 | $38.50 | $88.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $23.15 / $38.50
| Facility | | $11.02 | $23.15 | $38.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $22.78
| Professional | | $15.61 | $15.61 | $22.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $21.04 / $24.48
| Professional | | $14.22 | $21.04 | $24.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.49 / $20.73 / $38.50
| Professional | | $20.49 | $20.73 | $38.50 |