- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $46.77 / $147.91
| Facility | | $23.44 | $46.77 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $27.54 / $54.95 / $85.11
| Facility | CQ | $27.54 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $25.70 / $46.77
| Professional | | $16.98 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- CO
- Low / Median / High Price
- $51.29 / $51.29 / $51.29
| Professional | CO | $51.29 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $24.55 / $42.66 / $61.66
| Professional | CQ | $24.55 | $42.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $17.78 / $22.39 / $40.74
| Professional | CQ | $17.78 | $22.39 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $81.28 / $128.82
| Facility | | $47.86 | $81.28 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $33.11 / $45.71
| Professional | | $26.30 | $33.11 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $64.57 / $89.13
| Facility | | $60.26 | $64.57 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $26.92 / $50.12
| Professional | | $19.05 | $26.92 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.89 / $32.36 / $83.18
| Facility | | $20.89 | $32.36 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $63.10 / $128.82 / $128.82
| Facility | CQ | $63.10 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $31.62 / $218.78
| Professional | | $26.30 | $31.62 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $26.30 / $36.31
| Facility | | $24.55 | $26.30 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $30.20 / $35.48
| Professional | | $24.55 | $30.20 | $35.48 |