- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.07 / $29.83 / $197.52
| Facility | | $18.07 | $29.83 | $197.52 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $6.47 / $28.20 / $278.36
| Facility | CQ | $6.47 | $28.20 | $278.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $19.82 / $46.19
| Professional | | $13.00 | $19.82 | $46.19 |
- Facility/Professional
- Professional
- Modifier
- CO
- Low / Median / High Price
- $18.76 / $87.28 / $87.28
| Professional | CO | $18.76 | $87.28 | $87.28 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $17.62 / $29.86 / $59.72
| Professional | CQ | $17.62 | $29.86 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $14.80 / $18.48 / $23.00
| Professional | CQ | $14.80 | $18.48 | $23.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.91 / $27.68 / $41.00
| Facility | | $24.91 | $27.68 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.37 / $20.50 / $37.19
| Professional | | $15.37 | $20.50 | $37.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.55 / $29.38 / $36.44
| Facility | | $25.55 | $29.38 | $36.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.55 / $29.90 / $37.04
| Professional | | $25.55 | $29.90 | $37.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.46 / $65.00 / $82.00
| Facility | | $34.46 | $65.00 | $82.00 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $25.67 / $25.67 / $25.67
| Facility | CQ | $25.67 | $25.67 | $25.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $36.69 / $114.34
| Professional | | $17.35 | $36.69 | $114.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.41 / $32.34 / $32.34
| Professional | | $10.41 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.21 / $24.75 / $33.88
| Professional | | $21.21 | $24.75 | $33.88 |