| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $753.00 | $753.00 | $1,250.00 | |
Horizon BCBS
| Facility | $4,042.19 | $4,595.84 | $8,765.42 |
Unspecified Restorative Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $753.00 | $753.00 | $1,250.00 | |
Horizon BCBS
| Facility | $4,042.19 | $4,595.84 | $8,765.42 |