| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,518.41 | $3,706.14 | $7,381.16 | |
United
| Facility | $540.00 | $1,183.00 | $4,915.00 |
Exc Mucosa Vestibule Mouth As Don Grf
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,518.41 | $3,706.14 | $7,381.16 | |
United
| Facility | $540.00 | $1,183.00 | $4,915.00 |