| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $61.29 | $61.29 | $61.29 | |
Aetna
| Professional | $38.99 | $80.95 | $115.47 |
Consult Dx Serv Dent/Phy Not Requesting Dent/Phy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $61.29 | $61.29 | $61.29 | |
Aetna
| Professional | $38.99 | $80.95 | $115.47 |