| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $387.66 | $387.66 | $387.66 | |
Aetna
| Professional | $364.27 | $387.66 | $479.01 | |
Molina
| Professional | $45.00 | $45.00 | $655.36 |
Autogenous Connective Tissue Graft Procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $387.66 | $387.66 | $387.66 | |
Aetna
| Professional | $364.27 | $387.66 | $479.01 | |
Molina
| Professional | $45.00 | $45.00 | $655.36 |