| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Pacific Source
| Facility | $38.08 | $182.92 | $848.64 |
Free-Standing 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 |
|---|---|---|---|---|---|
Kaiser Permanente
| Facility | $200.00 | $200.00 | $322.00 | |
Pacific Source
| Facility | $38.08 | $182.92 | $848.64 |