- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.84 / $117.03 / $163.46
| Professional | 26 | $102.84 | $117.03 | $163.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $112.95 / $146.16 / $204.10
| Professional | 26 | $112.95 | $146.16 | $204.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $132.41 / $177.13 / $250.35
| Professional | 26 | $132.41 | $177.13 | $250.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.38 / $155.47 / $291.70
| Professional | 26 | $134.38 | $155.47 | $291.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $102.84 / $118.26 / $163.46
| Professional | 26 | $102.84 | $118.26 | $163.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $113.21 / $164.82 / $287.95
| Professional | 26 | $113.21 | $164.82 | $287.95 |