- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $3.23 / $5.49
| Facility | | $2.65 | $3.23 | $5.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $3.58
| Professional | | $2.65 | $2.65 | $3.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.12 / $2.12 / $2.65
| Facility | | $2.12 | $2.12 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $2.65 / $3.52
| Professional | | $2.35 | $2.65 | $3.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.22
| Facility | | $2.11 | $2.11 | $2.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.11 / $2.11
| Professional | | $2.11 | $2.11 | $2.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.50 / $2.65
| Facility | | $2.14 | $2.50 | $2.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.65
| Professional | | $2.65 | $2.65 | $2.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.50 / $3.75 / $332.00
| Facility | | $2.50 | $3.75 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $2.87 / $3.84
| Professional | | $2.87 | $2.87 | $3.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.70
| Facility | | $2.65 | $2.65 | $2.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.70
| Professional | | $2.65 | $2.65 | $2.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.14 / $2.50 / $555.00
| Facility | | $2.14 | $2.50 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.65 / $3.39
| Professional | | $2.56 | $2.65 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $3.71
| Professional | | $2.65 | $2.65 | $3.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $2.70 / $2.70
| Facility | | $2.70 | $2.70 | $2.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.65 / $2.70
| Professional | | $2.65 | $2.65 | $2.70 |