| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.54 | $144.54 | $144.54 | |
Aetna
| Professional | $128.82 | $144.54 | $169.82 |
Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.54 | $144.54 | $144.54 | |
Aetna
| Professional | $128.82 | $144.54 | $169.82 |