- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $19.50 / $21.38
| Facility | | $7.76 | $19.50 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.78 / $21.38 / $44.67
| Facility | 26 | $17.78 | $21.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $20.89 / $50.12
| Professional | | $10.00 | $20.89 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $46.77 / $138.04
| Professional | 26 | $15.85 | $46.77 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $56.23 / $57.54
| Professional | 26 | $56.23 | $56.23 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $6.03 / $12.59
| Facility | | $5.37 | $6.03 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $89.13 / $281.84
| Professional | | $77.62 | $89.13 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $72.44 / $128.82
| Professional | 26 | $7.41 | $72.44 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $11.48 / $50.12
| Facility | | $5.25 | $11.48 | $50.12 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $87.10 / $147.91
| Professional | | $53.70 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.12 / $83.18 / $138.04
| Professional | 26 | $50.12 | $83.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $46.77 / $109.65
| Professional | | $25.12 | $46.77 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $40.74 / $93.33
| Professional | 26 | $25.12 | $40.74 | $93.33 |