- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.56 / $10.56 / $179.00
| Facility | | $10.56 | $10.56 | $179.00 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $94.20 / $113.58 / $113.58
| Facility | CQ | $94.20 | $113.58 | $113.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.61 / $13.41 / $19.62
| Professional | | $8.61 | $13.41 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $7.17 / $7.17 / $7.17
| Professional | CQ | $7.17 | $7.17 | $7.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.07 / $15.38 / $33.61
| Facility | | $10.07 | $15.38 | $33.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.08 / $26.02 / $31.56
| Professional | | $14.08 | $26.02 | $31.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.28 / $37.89 / $62.42
| Facility | | $24.28 | $37.89 | $62.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.96 / $12.53 / $19.48
| Professional | | $9.96 | $12.53 | $19.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.57 / $37.06 / $49.15
| Facility | | $23.57 | $37.06 | $49.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $9.86 / $18.39
| Professional | | $9.86 | $9.86 | $18.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.77 / $19.07 / $116.76
| Facility | | $10.77 | $19.07 | $116.76 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $22.63 / $48.48 / $48.48
| Facility | CQ | $22.63 | $48.48 | $48.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $15.32 / $39.71
| Professional | | $10.81 | $15.32 | $39.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $15.72 / $39.46
| Professional | | $10.74 | $15.72 | $39.46 |