| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $448.42 | $2,080.00 | $4,100.00 | |
Kaiser Permanente
| Professional | $385.07 | $855.95 | $855.95 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 |
Exc Mucosa Vestibule Mouth As Don Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $448.42 | $2,080.00 | $4,100.00 | |
Kaiser Permanente
| Professional | $385.07 | $855.95 | $855.95 | |
United
| Facility | $165.00 | $442.00 | $5,940.00 |