| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |
Unlisted Ambulance Service (Special Coverage Instructions Apply. See Mcm: 2120.1 2125)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |