- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.43 / $77.06 / $206.98
| Facility | | $26.43 | $77.06 | $206.98 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $186.82 / $186.82 / $186.82
| Facility | CQ | $186.82 | $186.82 | $186.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $21.76 / $22.98
| Professional | | $14.40 | $21.76 | $22.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.75 / $23.02 / $105.60
| Professional | | $18.75 | $23.02 | $105.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.88 / $81.06 / $116.06
| Professional | | $27.88 | $81.06 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.26 / $32.34 / $32.34
| Professional | | $30.26 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.35 / $35.14 / $69.33
| Professional | | $20.35 | $35.14 | $69.33 |