| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $55.00 | $55.00 | $85.00 |
Unlisted Ambulance Service (Special Coverage Instructions Apply. See Mcm: 2120.1 2125)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $55.00 | $55.00 | $85.00 |