| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.26 | $90.26 | $90.26 | |
Aetna
| Professional | $90.26 | $90.26 | $111.55 | |
Molina
| Professional | $45.00 | $45.00 | $173.51 |
Extraction Eru Tooth Rqr Remv Bone &/Sectn Tooth
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $90.26 | $90.26 | $90.26 | |
Aetna
| Professional | $90.26 | $90.26 | $111.55 | |
Molina
| Professional | $45.00 | $45.00 | $173.51 |