| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $30.00 | $3,500.00 | $3,900.00 |
Unspecified Restorative Procedure By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $30.00 | $3,500.00 | $3,900.00 |