- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.10 / $15.48 / $19.66
| Facility | | $12.10 | $15.48 | $19.66 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $30.80 / $30.80 / $514.08
| Facility | CQ | $30.80 | $30.80 | $514.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.14 / $12.10 / $20.44
| Professional | | $9.14 | $12.10 | $20.44 |
- Facility/Professional
- Professional
- Modifier
- CO
- Low / Median / High Price
- $10.41 / $10.41 / $10.41
| Professional | CO | $10.41 | $10.41 | $10.41 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $8.85 / $8.85 / $8.85
| Professional | CQ | $8.85 | $8.85 | $8.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.87 / $29.76 / $54.49
| Facility | | $15.87 | $29.76 | $54.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $10.42 / $14.32
| Professional | | $10.09 | $10.42 | $14.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.05 / $12.05 / $12.05
| Facility | | $12.05 | $12.05 | $12.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.31 / $11.31 / $11.31
| Professional | | $11.31 | $11.31 | $11.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.83 / $13.29 / $21.02
| Professional | | $10.83 | $13.29 | $21.02 |