- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $123.03 / $416.87
| Facility | | $30.20 | $123.03 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- CO
- Low / Median / High Price
- $57.54 / $165.96 / $549.54
| Facility | CO | $57.54 | $165.96 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $58.88 / $128.82 / $524.81
| Facility | CQ | $58.88 | $128.82 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $44.67 / $144.54
| Professional | | $18.20 | $44.67 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $19.50 / $19.50 / $19.50
| Professional | 25 | $19.50 | $19.50 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- CO
- Low / Median / High Price
- $19.50 / $43.65 / $104.71
| Professional | CO | $19.50 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $24.55 / $57.54 / $144.54
| Professional | CQ | $24.55 | $57.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $95.50 / $239.88
| Facility | | $36.31 | $95.50 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $26.30 / $75.86
| Professional | | $18.62 | $26.30 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $70.79 / $117.49
| Facility | | $46.77 | $70.79 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- CO
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | CO | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | CQ | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $30.20 / $57.54
| Professional | | $19.50 | $30.20 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $28.84 / $31.62
| Facility | | $23.44 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $28.18 / $41.69
| Professional | | $22.39 | $28.18 | $41.69 |