| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.55 | $30.55 | $1,250.00 | |
Aetna
| Professional | $30.55 | $76.78 | $177.28 | |
Horizon BCBS
| Professional | $105.83 | $108.98 | $128.21 |
Plcmt Device Facilitate Eruption Impacted Tooth
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.55 | $30.55 | $1,250.00 | |
Aetna
| Professional | $30.55 | $76.78 | $177.28 | |
Horizon BCBS
| Professional | $105.83 | $108.98 | $128.21 |