- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.98 / $100.98 / $170.72
| Facility | 26 | $100.98 | $100.98 | $170.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $100.98 / $104.21 / $170.72
| Professional | 26 | $100.98 | $104.21 | $170.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $121.84 / $152.30 / $205.60
| Professional | 26 | $121.84 | $152.30 | $205.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $118.27 / $146.74 / $245.10
| Professional | 26 | $118.27 | $146.74 | $245.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $99.39 / $125.12 / $209.34
| Professional | 26 | $99.39 | $125.12 | $209.34 |