| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $275.20 | $372.64 | $8,500.00 | |
Medica
| Facility | $275.20 | $380.19 | $825.60 |
Exc Mucosa Vestibule Mouth As Don Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $275.20 | $372.64 | $8,500.00 | |
Medica
| Facility | $275.20 | $380.19 | $825.60 |