| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $2,632.00 | $5,000.00 | $57,255.43 | |
Capital Blue Cross
| Professional | $64,999.35 | $64,999.35 | $64,999.35 |
Unspecified Restorative Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Capital Blue Cross
| Facility | $2,632.00 | $5,000.00 | $57,255.43 | |
Capital Blue Cross
| Professional | $64,999.35 | $64,999.35 | $64,999.35 |