| 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 Other Non-RHC/FQHC Site (e.g. Scene of Accident)
| 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 |