| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $38.07 | $38.07 | $38.07 | |
Aetna
| Professional | $38.07 | $38.07 | $62.37 | |
Molina
| Professional | $45.00 | $45.00 | $77.40 |
Extraction Coronal Remnants-Primary Tooth
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $38.07 | $38.07 | $38.07 | |
Aetna
| Professional | $38.07 | $38.07 | $62.37 | |
Molina
| Professional | $45.00 | $45.00 | $77.40 |