| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $107.71 | $107.71 | $124.53 |
Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $107.71 | $107.71 | $124.53 |