| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.83 | $136.83 | $136.83 | |
Aetna
| Professional | $136.83 | $138.44 | $166.35 | |
Medica
| Facility | $114.25 | $138.44 | $227.08 | |
Medica
| Professional | $68.09 | $179.75 | $1,053.42 |
Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.83 | $136.83 | $136.83 | |
Aetna
| Professional | $136.83 | $138.44 | $166.35 | |
Medica
| Facility | $114.25 | $138.44 | $227.08 | |
Medica
| Professional | $68.09 | $179.75 | $1,053.42 |