| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $223.20 | $3,038.00 | $4,387.00 | |
Aetna
| Professional | $223.20 | $223.20 | $458.00 | |
Molina
| Professional | $45.00 | $45.00 | $405.70 |
Remv Imp Tooth - Cmpl Bony W/Unusual Surg Comps
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $223.20 | $3,038.00 | $4,387.00 | |
Aetna
| Professional | $223.20 | $223.20 | $458.00 | |
Molina
| Professional | $45.00 | $45.00 | $405.70 |