| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $176.56 | $176.56 | $176.56 |
Remv Imp Tooth - Cmpl Bony W/Unusual Surg Comps
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $176.56 | $176.56 | $176.56 |