- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.08 / $31.58 / $49.09
| Professional | | $24.08 | $31.58 | $49.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.12 / $23.77 / $34.36
| Professional | 26 | $16.12 | $23.77 | $34.36 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.04 / $15.79 / $25.76
| Professional | 52 | $12.04 | $15.79 | $25.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $1.32 / $4.15 / $31.13
| Professional | TC | $1.32 | $4.15 | $31.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.22 / $41.63 / $65.02
| Professional | | $24.22 | $41.63 | $65.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.59 / $29.63 / $38.99
| Professional | 26 | $20.59 | $29.63 | $38.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.22 / $7.27 / $34.34
| Professional | TC | $3.22 | $7.27 | $34.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.15 / $65.70 / $102.93
| Professional | | $33.15 | $65.70 | $102.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.21 / $26.54 / $60.06
| Professional | 26 | $22.21 | $26.54 | $60.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.07 / $39.04 / $57.38
| Professional | TC | $5.07 | $39.04 | $57.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.93 / $32.93 / $74.68
| Professional | | $32.93 | $32.93 | $74.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.74 / $23.74 / $28.15
| Professional | 26 | $23.74 | $23.74 | $28.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.79 / $4.79 / $50.94
| Professional | TC | $4.79 | $4.79 | $50.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.66 / $40.34 / $78.31
| Professional | | $26.66 | $40.34 | $78.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.05 / $27.46 / $57.77
| Professional | 26 | $20.05 | $27.46 | $57.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.91 / $5.72 / $49.15
| Professional | TC | $3.91 | $5.72 | $49.15 |