| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $199.53 | $199.53 | $338.84 | |
Pacific Source
| Facility | $38.02 | $181.97 | $851.14 |
Freestanding Clinic-Visit by RHC/FQHC Practitioner to a Member in a SNF (Not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $199.53 | $199.53 | $338.84 | |
Pacific Source
| Facility | $38.02 | $181.97 | $851.14 |