- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.31 / $2,003.12 / $3,648.54
| Facility | | $5.31 | $2,003.12 | $3,648.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $5.62 / $6.80
| Professional | | $5.57 | $5.62 | $6.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $5.31 / $5.57
| Professional | | $5.31 | $5.31 | $5.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $5.57 / $7.09
| Professional | | $5.57 | $5.57 | $7.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $5.57 / $5.61
| Professional | | $5.57 | $5.57 | $5.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $5.57 / $5.90
| Professional | | $5.57 | $5.57 | $5.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $5.31 / $5.31
| Professional | | $5.31 | $5.31 | $5.31 |