| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $161.96 | $161.96 | $162.18 | |
Providence
| Facility | $88.39 | $200.94 | $259.33 | |
Providence
| Professional | $162.40 | $250.31 | $1,800,000.00 |
Bone Repl Gr - Ret Nat Tooth - Ea Add Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $161.96 | $161.96 | $162.18 | |
Providence
| Facility | $88.39 | $200.94 | $259.33 | |
Providence
| Professional | $162.40 | $250.31 | $1,800,000.00 |