| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,677.16 | $6,677.16 | $6,677.16 | |
Martin's Point
| Facility | $6,677.16 | $6,677.16 | $6,677.16 |
Exc Mucosa Vestibule Mouth As Don Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,677.16 | $6,677.16 | $6,677.16 | |
Martin's Point
| Facility | $6,677.16 | $6,677.16 | $6,677.16 |