| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $177.69 | $177.69 | $177.70 | |
CareSource
| Professional | $121.50 | $121.50 | $121.50 |
Unlisted procedure, vestibule of mouth
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,400.00 | $1,400.00 | $2,600.00 | |
CareSource
| Facility | $177.69 | $177.69 | $177.70 | |
CareSource
| Professional | $121.50 | $121.50 | $121.50 |