| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $362.10 | $763.88 | $2,126.00 | |
United
| Facility | $1,204.00 | $1,640.00 | $2,126.00 |
Unlisted Maxillofacial Prosthetic Procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $362.10 | $763.88 | $2,126.00 | |
United
| Facility | $1,204.00 | $1,640.00 | $2,126.00 |