| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $126.39 | $126.39 | $150.60 |
Bone Repl Graft - Ret Nat Tooth - 1st Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $126.39 | $126.39 | $150.60 |