| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $204.50 | $204.50 | $204.50 | |
Providence
| Facility | $246.68 | $246.68 | $246.68 | |
Providence
| Professional | $204.78 | $307.19 | $443.10 |
Alveoloplsty Not Cnjnc Xtrct 1-3 Teeth/Spce Quad
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $204.50 | $204.50 | $204.50 | |
Providence
| Facility | $246.68 | $246.68 | $246.68 | |
Providence
| Professional | $204.78 | $307.19 | $443.10 |