| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $3,850.00 | $3,850.00 | $3,850.00 |
Special Charges - Admission Charge
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Facility | $3,850.00 | $3,850.00 | $3,850.00 |