- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.82 / $22.12 / $23.89
| Facility | | $21.82 | $22.12 | $23.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.95 / $22.76 / $29.49
| Professional | | $17.95 | $22.76 | $29.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.75 / $27.75 / $27.75
| Professional | | $27.75 | $27.75 | $27.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.47 / $39.47 / $39.47
| Facility | | $39.47 | $39.47 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $13.74 / $13.74
| Professional | | $13.74 | $13.74 | $13.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.37 / $157.62 / $159.97
| Facility | | $68.37 | $157.62 | $159.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.60 / $256.19 / $266.43
| Professional | | $252.60 | $256.19 | $266.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.33 / $33.68 / $61.07
| Facility | | $22.33 | $33.68 | $61.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.63 / $32.00 / $33.68
| Professional | | $28.63 | $32.00 | $33.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.01 / $37.78 / $58.94
| Professional | | $33.01 | $37.78 | $58.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.41 / $33.68 / $61.07
| Facility | | $22.41 | $33.68 | $61.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $13.74 / $28.00
| Professional | | $13.74 | $13.74 | $28.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.90 / $15.27 / $23.14
| Professional | | $11.90 | $15.27 | $23.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.68 / $33.68 / $45.47
| Professional | | $33.68 | $33.68 | $45.47 |