| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $194.25 | $194.25 | $196.05 | |
Providence
| Facility | $135.19 | $236.95 | $304.87 | |
Providence
| Professional | $196.36 | $294.58 | $1,800,000.00 |
Bone Repl Graft - Ret Nat Tooth - 1st Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $194.25 | $194.25 | $196.05 | |
Providence
| Facility | $135.19 | $236.95 | $304.87 | |
Providence
| Professional | $196.36 | $294.58 | $1,800,000.00 |