| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.10 | $16.10 | $16.10 | |
Aetna
| Professional | $14.31 | $16.10 | $19.98 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |
Periodic Oral Evaluation
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.10 | $16.10 | $16.10 | |
Aetna
| Professional | $14.31 | $16.10 | $19.98 | |
Molina
| Professional | $30.00 | $45.00 | $60.00 |