- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $134.90 / $346.74
| Facility | | $33.11 | $134.90 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $28.84 / $63.10
| Professional | | $17.78 | $28.84 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Professional | CQ | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $74.13 / $147.91
| Facility | | $34.67 | $74.13 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $77.62 / $112.20
| Professional | | $42.66 | $77.62 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Professional | CQ | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $162.18 / $213.80
| Facility | | $95.50 | $162.18 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $64.57
| Professional | | $32.36 | $40.74 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $154.88 / $165.96
| Facility | | $107.15 | $154.88 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $51.29
| Professional | | $32.36 | $32.36 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $66.07 / $134.90
| Facility | | $33.11 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $39.81 / $112.20
| Professional | | $33.88 | $39.81 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $40.74 / $40.74
| Facility | | $37.15 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $39.81 / $107.15
| Professional | | $33.88 | $39.81 | $107.15 |