| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $877.03 | $877.03 | $877.03 | |
Providence
| Facility | $539.35 | $595.15 | $1,242.20 |
Exc Lip Full Thkns Rcnstj W/Local Flap
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $877.03 | $877.03 | $877.03 | |
Providence
| Facility | $539.35 | $595.15 | $1,242.20 |