| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,005.81 | $1,005.81 | $1,005.81 |
Conjunctpl Cul-De-Sac W/Buccal Muc Memb Graft
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1,005.81 | $1,005.81 | $1,005.81 |