- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $34.67 / $57.54
| Facility | | $10.96 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $26.30
| Professional | | $8.91 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $14.45 / $14.45 / $14.45
| Professional | CQ | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $45.71 / $151.36
| Professional | | $11.48 | $45.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $33.88
| Professional | | $10.96 | $14.13 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $29.51
| Professional | | $16.22 | $16.22 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $16.22 / $16.22
| Facility | | $12.02 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $32.36
| Professional | | $12.02 | $16.98 | $32.36 |