- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.00 / $3,171.00 / $6,391.33
| Facility | | $1,393.00 | $3,171.00 | $6,391.33 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,183.25 / $2,183.25 / $2,183.25
| Facility | 50 | $2,183.25 | $2,183.25 | $2,183.25 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $658.83 / $658.83 / $666.49
| Facility | 52 | $658.83 | $658.83 | $666.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,088.00 / $6,151.00 / $13,808.43
| Facility | | $5,088.00 | $6,151.00 | $13,808.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.48 / $1,490.40 / $2,096.87
| Professional | | $18.48 | $1,490.40 | $2,096.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.00 / $2,947.00 / $7,221.00
| Facility | | $1,282.00 | $2,947.00 | $7,221.00 |