- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.96 / $45.60 / $58.25
| Facility | | $20.96 | $45.60 | $58.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.57 / $44.88 / $64.26
| Facility | 26 | $34.57 | $44.88 | $64.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $46.54 / $77.23
| Professional | | $15.66 | $46.54 | $77.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.66 / $43.93 / $71.68
| Professional | 26 | $15.66 | $43.93 | $71.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.48 / $14.44 / $17.05
| Facility | | $7.48 | $14.44 | $17.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.66 / $50.46 / $81.31
| Professional | | $19.66 | $50.46 | $81.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.49 / $18.41 / $54.33
| Professional | 26 | $7.49 | $18.41 | $54.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.45 / $7.53 / $27.54
| Facility | | $4.45 | $7.53 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.60 / $52.60 / $52.60
| Facility | 26 | $52.60 | $52.60 | $52.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.45 / $43.45 / $43.45
| Professional | | $43.45 | $43.45 | $43.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.47 / $40.47 / $40.47
| Professional | 26 | $40.47 | $40.47 | $40.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $2.63 / $2.63
| Facility | | $2.63 | $2.63 | $2.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.57 / $26.23 / $57.87
| Professional | | $18.57 | $26.23 | $57.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.55 / $26.11 / $57.34
| Professional | 26 | $18.55 | $26.11 | $57.34 |