| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $105.00 | $105.00 | $115.50 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |
Unspecified Orthodontic Procedure By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $105.00 | $105.00 | $115.50 | |
Molina
| Professional | $17.00 | $25.00 | $50.00 |