- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.68 / $21.60 / $68.79
| Facility | | $11.68 | $21.60 | $68.79 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $20.32 / $20.32 / $20.32
| Facility | CQ | $20.32 | $20.32 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.68 / $11.68 / $73.20
| Professional | | $11.68 | $11.68 | $73.20 |
- Facility/Professional
- Professional
- Modifier
- CQ
- Low / Median / High Price
- $7.69 / $8.76 / $20.27
| Professional | CQ | $7.69 | $8.76 | $20.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.07 / $148.72 / $287.66
| Facility | | $113.07 | $148.72 | $287.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $18.01 / $24.27
| Professional | | $10.68 | $18.01 | $24.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.00 / $48.00 / $48.00
| Facility | | $48.00 | $48.00 | $48.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $18.44 / $28.48
| Professional | | $13.45 | $18.44 | $28.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.68 / $71.04 / $102.72
| Facility | | $11.68 | $71.04 | $102.72 |
- Facility/Professional
- Facility
- Modifier
- CQ
- Low / Median / High Price
- $48.89 / $48.89 / $48.89
| Facility | CQ | $48.89 | $48.89 | $48.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.52 / $28.37 / $37.74
| Professional | | $20.52 | $28.37 | $37.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.58 / $22.11 / $32.43
| Facility | | $14.58 | $22.11 | $32.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $22.11 / $33.65
| Professional | | $15.51 | $22.11 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $28.74 / $32.28
| Professional | | $21.06 | $28.74 | $32.28 |