- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.86 / $45.31 / $56.81
| Facility | | $2.86 | $45.31 | $56.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.71 / $17.71 / $53.53
| Facility | 26 | $17.71 | $17.71 | $53.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.70 / $55.40 / $56.81
| Professional | | $47.70 | $55.40 | $56.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.07 / $53.53 / $53.60
| Professional | 26 | $45.07 | $53.53 | $53.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.38 / $44.38 / $44.38
| Professional | 26 | $44.38 | $44.38 | $44.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.80 / $59.53 / $65.36
| Professional | | $44.80 | $59.53 | $65.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.13 / $8.75 / $26.87
| Facility | | $2.13 | $8.75 | $26.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.45 / $43.45 / $69.06
| Professional | | $43.45 | $43.45 | $69.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.47 / $40.47 / $64.77
| Professional | 26 | $40.47 | $40.47 | $64.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.55 / $58.17 / $81.23
| Facility | | $25.55 | $58.17 | $81.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $87.68 / $223.26 / $223.26
| Facility | 26 | $87.68 | $223.26 | $223.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.89 / $21.25 / $58.63
| Professional | | $15.89 | $21.25 | $58.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.32 / $20.62 / $41.18
| Professional | 26 | $15.32 | $20.62 | $41.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $20.63 / $37.13
| Professional | | $15.31 | $20.63 | $37.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.30 / $20.62 / $37.11
| Professional | 26 | $15.30 | $20.62 | $37.11 |