- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.98 / $33.98 / $33.98
| Facility | | $33.98 | $33.98 | $33.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.29 / $16.29 / $16.29
| Facility | 26 | $16.29 | $16.29 | $16.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.21 / $34.97 / $54.31
| Professional | | $27.21 | $34.97 | $54.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.36 / $15.62 / $21.01
| Professional | 26 | $13.36 | $15.62 | $21.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.69 / $17.96 / $33.75
| Professional | TC | $13.69 | $17.96 | $33.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.88 / $149.41 / $263.33
| Facility | | $117.88 | $149.41 | $263.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $40.28 / $66.18
| Professional | | $28.87 | $40.28 | $66.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.77 / $18.07 / $28.18
| Professional | 26 | $13.77 | $18.07 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.21 / $21.18 / $39.41
| Professional | TC | $15.21 | $21.18 | $39.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.28 / $37.28 / $37.28
| Facility | | $37.28 | $37.28 | $37.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.95 / $17.95 / $17.95
| Facility | 26 | $17.95 | $17.95 | $17.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.70 / $44.65 / $82.51
| Professional | | $26.70 | $44.65 | $82.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.89 / $20.01 / $33.15
| Professional | 26 | $12.89 | $20.01 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.91 / $23.87 / $46.20
| Professional | TC | $13.91 | $23.87 | $46.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.55 / $44.55 / $44.55
| Facility | | $44.55 | $44.55 | $44.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $37.72 / $63.05
| Professional | | $27.43 | $37.72 | $63.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $16.68 / $27.84
| Professional | 26 | $12.88 | $16.68 | $27.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.08 / $19.93 / $36.22
| Professional | TC | $14.08 | $19.93 | $36.22 |