- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.56 / $12.45 / $20.68
| Facility | | $10.56 | $12.45 | $20.68 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $113.58 / $113.58 / $113.58
| Facility | CQ | $113.58 | $113.58 | $113.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.76 / $19.28
| Professional | | $10.56 | $13.76 | $19.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.76 / $25.95 / $30.53
| Professional | | $22.76 | $25.95 | $30.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $12.33 / $15.35
| Professional | | $9.86 | $12.33 | $15.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.56 / $14.55 / $100.00
| Facility | | $10.56 | $14.55 | $100.00 |
- 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
- $10.74 / $16.64 / $34.85
| Professional | | $10.74 | $16.64 | $34.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.49 / $12.47 / $29.01
| Professional | | $10.49 | $12.47 | $29.01 |