- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.36 / $45.36 / $45.36
| Facility | | $45.36 | $45.36 | $45.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.57 / $42.57 / $42.57
| Facility | 26 | $42.57 | $42.57 | $42.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $43.48 / $77.23
| Professional | | $15.66 | $43.48 | $77.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.66 / $41.06 / $71.68
| Professional | 26 | $15.66 | $41.06 | $71.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.42 / $6.46 / $12.78
| Facility | | $2.42 | $6.46 | $12.78 |
- 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
- $43.48 / $50.50 / $71.73
| Facility | | $43.48 | $50.50 | $71.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.98 / $82.65 / $94.46
| Professional | | $76.98 | $82.65 | $94.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $72.58 / $76.98 / $87.98
| Professional | 26 | $72.58 | $76.98 | $87.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $32.34 / $88.45
| Professional | | $5.44 | $32.34 | $88.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.04 / $73.13 / $76.94
| Professional | | $27.04 | $73.13 | $76.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.04 / $68.16 / $72.23
| Professional | 26 | $27.04 | $68.16 | $72.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $27.37 / $39.78
| Professional | | $19.77 | $27.37 | $39.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.76 / $24.20 / $39.76
| Professional | 26 | $19.76 | $24.20 | $39.76 |