| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $167.78 | $167.78 | $167.78 | |
Aetna
| Professional | $124.82 | $167.78 | $173.20 |
Bone Repl Graft - Ret Nat Tooth - 1st Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $167.78 | $167.78 | $167.78 | |
Aetna
| Professional | $124.82 | $167.78 | $173.20 |