| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $159.87 | $159.87 | $159.87 | |
Aetna
| Professional | $159.87 | $177.43 | $194.16 | |
Molina
| Professional | $30.00 | $45.00 | $258.11 |
Bone Replacement Graft - Retained Natural Tooth - First Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $159.87 | $159.87 | $159.87 | |
Aetna
| Professional | $159.87 | $177.43 | $194.16 | |
Molina
| Professional | $30.00 | $45.00 | $258.11 |