| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $107.71 | $107.71 | $124.53 |
Bone Repl Gr - Ret Nat Tooth - Ea Add Site Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $107.71 | $107.71 | $124.53 |