| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,144.00 | $8,043.00 | |
Kaiser Permanente
| Professional | $1,842.93 | $3,844.30 | $3,844.30 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |
Optx&/Rdctj Odntd Fx&/Dislc Ant Fixj W/O Graft
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,614.00 | $4,144.00 | $8,043.00 | |
Kaiser Permanente
| Professional | $1,842.93 | $3,844.30 | $3,844.30 | |
United
| Facility | $4,062.00 | $5,185.00 | $19,046.00 |