- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.04 / $16.04 / $26.44
| Facility | | $16.04 | $16.04 | $26.44 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $34.01 / $34.01 / $34.01
| Facility | CQ | $34.01 | $34.01 | $34.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $13.48 / $16.04
| Professional | | $8.36 | $13.48 | $16.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.00 / $75.00 / $100.00
| Facility | | $70.00 | $75.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.99 / $16.64 / $114.34
| Professional | | $11.99 | $16.64 | $114.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.51 / $14.05 / $20.52
| Facility | | $10.51 | $14.05 | $20.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $22.95 / $27.82
| Professional | | $13.05 | $22.95 | $27.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $32.34 / $32.34
| Professional | | $20.32 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.48 / $20.97 / $32.04
| Facility | | $17.48 | $20.97 | $32.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.78 / $15.04 / $20.60
| Professional | | $12.78 | $15.04 | $20.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $13.32 / $14.80
| Professional | | $12.25 | $13.32 | $14.80 |