| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,343.66 | $6,343.66 | $6,343.66 | |
Molina
| Professional | $50.00 | $58.40 | $70.00 |
Unspecified Restorative Procedure By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6,343.66 | $6,343.66 | $6,343.66 | |
Molina
| Professional | $50.00 | $58.40 | $70.00 |