- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $125.89 / $331.13
| Professional | 26 | $100.00 | $125.89 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $87.10 / $120.23 / $186.21
| Professional | 26 | $87.10 | $120.23 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.79 / $120.23 / $204.17
| Professional | 26 | $70.79 | $120.23 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $128.82 / $251.19
| Professional | 26 | $109.65 | $128.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.33 / $125.89 / $331.13
| Professional | 26 | $102.33 | $125.89 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $109.65 / $138.04 / $194.98
| Professional | 26 | $109.65 | $138.04 | $194.98 |