- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.90 / $17.26 / $58.05
| Facility | | $12.90 | $17.26 | $58.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.90 / $13.28 / $14.55
| Facility | 26 | $12.90 | $13.28 | $14.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $15.66 / $77.23
| Professional | | $12.90 | $15.66 | $77.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.90 / $15.66 / $71.68
| Professional | 26 | $12.90 | $15.66 | $71.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.80 / $23.80 / $23.80
| Professional | 26 | $23.80 | $23.80 | $23.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $20.02 / $45.56
| Professional | | $17.05 | $20.02 | $45.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.35 / $41.35 / $42.47
| Professional | 26 | $41.35 | $41.35 | $42.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.89 / $44.89 / $44.89
| Facility | | $44.89 | $44.89 | $44.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Professional | 26 | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.44 / $23.94 / $51.93
| Facility | | $3.44 | $23.94 | $51.93 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $22.01 / $38.34
| Professional | | $17.23 | $22.01 | $38.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.22 / $21.59 / $36.84
| Professional | 26 | $17.22 | $21.59 | $36.84 |