- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.51 / $3.72 / $63.10
| Facility | | $2.51 | $3.72 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | 26 | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $48.98 / $61.66
| Professional | | $16.98 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $46.77 / $64.57
| Professional | 26 | $16.98 | $46.77 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $50.12 / $57.54
| Professional | 26 | $40.74 | $50.12 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $81.28
| Facility | | $50.12 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $11.22 / $17.38
| Professional | 26 | $8.91 | $11.22 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $6.61 / $13.18
| Facility | | $2.57 | $6.61 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | 26 | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.63 / $2.95 / $16.98
| Facility | | $2.63 | $2.95 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $19.05 / $26.30
| Professional | | $14.45 | $19.05 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $19.05 / $26.30
| Professional | 26 | $14.79 | $19.05 | $26.30 |