- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.76 / $25.42 / $102.14
| Facility | | $15.76 | $25.42 | $102.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $14.40 / $20.19
| Professional | | $10.74 | $14.40 | $20.19 |
- Facility/Professional
- Professional
- Modifier
- CO
- Low / Median / High Price
- $12.35 / $12.35 / $12.35
| Professional | CO | $12.35 | $12.35 | $12.35 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $12.70 / $17.45 / $17.45
| Professional | CQ | $12.70 | $17.45 | $17.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $51.23 / $87.67
| Facility | | $32.36 | $51.23 | $87.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.70 / $16.60 / $27.42
| Professional | | $12.70 | $16.60 | $27.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $65.00 / $82.00
| Facility | | $55.00 | $65.00 | $82.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.87 / $26.62 / $111.17
| Professional | | $14.87 | $26.62 | $111.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.84 / $18.12 / $26.70
| Professional | | $14.84 | $18.12 | $26.70 |