- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.61 / $3.18 / $5.22
| Facility | | $2.61 | $3.18 | $5.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $3.52
| Professional | | $2.61 | $2.61 | $3.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.09 / $2.09 / $2.61
| Facility | | $2.09 | $2.09 | $2.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.49 / $2.61 / $2.61
| Professional | | $2.49 | $2.61 | $2.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.31 / $2.31 / $2.43
| Facility | | $2.31 | $2.31 | $2.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $2.31 / $2.31
| Professional | | $2.31 | $2.31 | $2.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $2.46 / $2.61
| Facility | | $2.39 | $2.46 | $2.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $2.61
| Professional | | $2.61 | $2.61 | $2.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.46 / $3.69 / $332.00
| Facility | | $2.46 | $3.69 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.83 / $2.83 / $3.37
| Professional | | $2.83 | $2.83 | $3.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $2.71
| Facility | | $2.61 | $2.61 | $2.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $2.71
| Professional | | $2.61 | $2.61 | $2.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.39 / $2.46 / $555.00
| Facility | | $2.39 | $2.46 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $3.57
| Professional | | $2.61 | $2.61 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $3.66
| Professional | | $2.61 | $2.61 | $3.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.71 / $2.71 / $2.71
| Facility | | $2.71 | $2.71 | $2.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.61 / $2.61 / $2.71
| Professional | | $2.61 | $2.61 | $2.71 |