- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.22 / $54.18 / $237.78
| Facility | | $22.22 | $54.18 | $237.78 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $55.68 / $117.11 / $476.79
| Facility | CQ | $55.68 | $117.11 | $476.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $20.26 / $21.10
| Professional | | $13.00 | $20.26 | $21.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.69 / $21.69 / $105.60
| Professional | | $21.69 | $21.69 | $105.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.00 / $81.30 / $116.06
| Professional | | $28.00 | $81.30 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.56 / $30.50 / $30.50
| Professional | | $28.56 | $30.50 | $30.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $32.61 / $63.66
| Professional | | $21.20 | $32.61 | $63.66 |