| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $258.00 | $258.00 | $258.00 | |
Providence
| Facility | $258.00 | $258.00 | $258.00 |
Freestanding Clinic-Visit by RHC/FQHC Practitioner to Other Non-RHC/FQHC Site (e.g. Scene of Accident)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $258.00 | $258.00 | $258.00 | |
Providence
| Facility | $258.00 | $258.00 | $258.00 |