| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,733.21 | $2,884.50 | $9,148.50 | |
Medica
| Facility | $125.00 | $2,691.47 | $4,341.37 | |
United
| Facility | $125.00 | $125.00 | $125.00 |
Unlisted Procedure Dentoalveolar Structures
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,733.21 | $2,884.50 | $9,148.50 | |
Medica
| Facility | $125.00 | $2,691.47 | $4,341.37 | |
United
| Facility | $125.00 | $125.00 | $125.00 |