| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.04 | $74.04 | $74.04 | |
Aetna
| Professional | $27.01 | $74.04 | $98.18 | |
Molina
| Professional | $30.00 | $45.00 | $80.00 |
Consult Dx Serv Dent/Phy Not Requesting Dent/Phy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.04 | $74.04 | $74.04 | |
Aetna
| Professional | $27.01 | $74.04 | $98.18 | |
Molina
| Professional | $30.00 | $45.00 | $80.00 |