| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $134.80 | $134.80 | $134.80 | |
Aetna
| Professional | $134.80 | $191.09 | $406.91 |
Bone Repl Graft - Ret Nat Tooth - 1st Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $134.80 | $134.80 | $134.80 | |
Aetna
| Professional | $134.80 | $191.09 | $406.91 |