- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $8.32
| Facility | | $8.32 | $8.32 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.03 / $8.36 / $10.97
| Professional | | $7.03 | $8.36 | $10.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.44 / $75.00 / $75.00
| Facility | | $16.44 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.68 / $15.08 / $55.28
| Professional | | $9.68 | $15.08 | $55.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $7.74 / $11.11
| Professional | | $7.74 | $7.74 | $11.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $8.75 / $9.98
| Facility | | $7.08 | $8.75 | $9.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.70 / $11.58 / $17.76
| Professional | | $7.70 | $11.58 | $17.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $21.11 / $27.03
| Professional | | $10.65 | $21.11 | $27.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.44 / $75.00 / $75.00
| Facility | | $16.44 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.68 / $15.08 / $55.28
| Professional | | $9.68 | $15.08 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $13.36 / $25.15
| Professional | | $9.38 | $13.36 | $25.15 |