| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,466.84 | $4,466.84 | $4,466.84 | |
Aetna
| Professional | $331.13 | $1,659.59 | $38,904.51 |
Unlisted procedure, dentoalveolar structures
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,466.84 | $4,466.84 | $4,466.84 | |
Aetna
| Professional | $331.13 | $1,659.59 | $38,904.51 |