| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.22 | $136.22 | $136.22 | |
Aetna
| Professional | $136.22 | $146.72 | $160.51 | |
Molina
| Professional | $30.00 | $45.00 | $162.18 |
Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $136.22 | $136.22 | $136.22 | |
Aetna
| Professional | $136.22 | $146.72 | $160.51 | |
Molina
| Professional | $30.00 | $45.00 | $162.18 |