- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $21.88 / $23.44
| Facility | | $13.49 | $21.88 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | CQ | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $12.88 / $39.81
| Professional | | $7.94 | $12.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $8.71 / $28.18 / $30.20
| Professional | CQ | $8.71 | $28.18 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $23.99 / $38.90
| Facility | | $17.38 | $23.99 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $22.39 / $24.55
| Professional | | $12.88 | $22.39 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $75.86 / $100.00
| Facility | | $70.79 | $75.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $12.30 / $22.39
| Professional | | $11.22 | $12.30 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $14.79 / $29.51
| Facility | | $10.00 | $14.79 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | CQ | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $19.05 / $23.99
| Professional | | $10.96 | $19.05 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $7.94 / $22.91 / $30.20
| Professional | CQ | $7.94 | $22.91 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $17.38 / $26.92
| Facility | | $17.38 | $17.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $12.59 / $17.38
| Professional | | $11.48 | $12.59 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.75 / $30.20
| Professional | | $10.96 | $11.75 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $12.59 / $19.50
| Professional | | $10.72 | $12.59 | $19.50 |