| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $380.00 | $1,200.00 | $2,531.73 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |
Special Charges - Admission Charge
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Health Alliance Plan
| Facility | $380.00 | $1,200.00 | $2,531.73 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |