- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $239.88
| Professional | | $100.00 | $144.54 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $154.88 / $154.88
| Professional | | $31.62 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $151.36 / $229.09
| Professional | | $95.50 | $151.36 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $229.09
| Professional | | $104.71 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $154.88 / $229.09
| Professional | | $104.71 | $154.88 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $218.78
| Professional | | $104.71 | $147.91 | $218.78 |