| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $111.51 | $111.51 | $111.51 | |
Aetna
| Professional | $111.51 | $157.11 | $347.62 |
Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $111.51 | $111.51 | $111.51 | |
Aetna
| Professional | $111.51 | $157.11 | $347.62 |