| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $574.00 | $574.00 | $574.00 | |
Aetna
| Professional | $574.00 | $574.00 | $574.00 | |
Cigna
| Professional | $366.38 | $370.04 | $465.30 | |
Medica
| Facility | $574.00 | $574.00 | $1,423.10 |
Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $574.00 | $574.00 | $574.00 | |
Aetna
| Professional | $574.00 | $574.00 | $574.00 | |
Cigna
| Professional | $366.38 | $370.04 | $465.30 | |
Medica
| Facility | $574.00 | $574.00 | $1,423.10 |