- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $125.00 / $265.00
| Professional | 26 | $93.63 | $125.00 | $265.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.54 / $116.58 / $186.60
| Professional | 26 | $93.54 | $116.58 | $186.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.54 / $145.19 / $197.48
| Professional | 26 | $112.54 | $145.19 | $197.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $111.29 / $128.76 / $241.59
| Professional | 26 | $111.29 | $128.76 | $241.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.63 / $125.00 / $156.68
| Professional | 26 | $93.63 | $125.00 | $156.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $92.66 / $138.91 / $181.75
| Professional | 26 | $92.66 | $138.91 | $181.75 |