| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.93 | $178.06 | $196.71 | |
Medica
| Facility | $165.77 | $202.35 | $361.46 | |
Medica
| Professional | $1,274.00 | $1,274.00 | $1,274.00 |
Bone Replacement Graft - Retained Natural Tooth - First Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.93 | $178.06 | $196.71 | |
Medica
| Facility | $165.77 | $202.35 | $361.46 | |
Medica
| Professional | $1,274.00 | $1,274.00 | $1,274.00 |