| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $263.58 | $263.58 | $263.58 | |
Providence
| Facility | $456.67 | $456.67 | $456.67 | |
Providence
| Professional | $263.98 | $396.00 | $571.20 |
Osseous Surg 1-3 Contig/Tooth Bound Spaces-Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $263.58 | $263.58 | $263.58 | |
Providence
| Facility | $456.67 | $456.67 | $456.67 | |
Providence
| Professional | $263.98 | $396.00 | $571.20 |