| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $4,466.84 | $4,466.84 | $4,466.84 |
Room & Board Other-Hospital at Home
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $4,466.84 | $4,466.84 | $4,466.84 |