| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |
Special Charges - Admission Charge
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |