| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $13.80 | $13.80 | $13.80 |
Unlisted Ambulance Service (Special Coverage Instructions Apply. See Mcm: 2120.1 2125)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $13.80 | $13.80 | $13.80 |