| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $5,685.42 | $5,685.42 | $5,685.42 | |
United
| Facility | $5,685.42 | $5,685.42 | $5,685.42 |
Extreme Immaturity or Respiratory Distress Syndrome, Neonate
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $5,685.42 | $5,685.42 | $5,685.42 | |
United
| Facility | $5,685.42 | $5,685.42 | $5,685.42 |