| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $446.09 | $446.09 | $446.09 | |
Aetna
| Professional | $339.35 | $446.09 | $460.44 | |
Molina
| Professional | $30.00 | $45.00 | $780.01 |
Osseous Surg 4/> Contig/Tooth Bound Spaces-Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $446.09 | $446.09 | $446.09 | |
Aetna
| Professional | $339.35 | $446.09 | $460.44 | |
Molina
| Professional | $30.00 | $45.00 | $780.01 |