[Nickshu]

Her case looks pretty straightforward except for the lower arch. Is she congenitally missing her lower second premolars? I see some retained primary (baby) second molars in there. This does make it more challenging to achieve a class 1 molar occlusion (ideal/desired). What I usually see is those retained primary second molars last until about the mid-30's then usually are lost due to root resorption, then they land in my chair for implants. I would leave them in place for now but future care to address these areas is likely. The reason this is challenging is the primary molars are about 20-30% longer than the permanent teeth that are supposed to be there.

As far as negotiating, in my practice I offer a 10-20% discount for anyone who pays cash up front (cash or check, not credit card). Maybe an angle to try. What I observe is the willingness for Dr's to negotiate depends on how saturated their market is. Guys in SF or LA where there's an orthodontist struggling on every corner are much more willing to negotiate fees, where you are at in Montana you are less likely to see people willing to do this. From a business perspective when I give a patient a 20% discount I cannot turn around and pay my staff 20% less, or pay the electric company or dental supplier 20% less.