| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $420.11 | $420.11 | $420.11 | |
Providence
| Facility | $258.52 | $585.00 | $648.95 |
Excision of mucosa of vestibule of mouth as donor graft
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $420.11 | $420.11 | $420.11 | |
Providence
| Facility | $258.52 | $585.00 | $648.95 |