| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Midlands
| Professional | $109.95 | $109.95 | $135.71 |
Heavy-duty shock absorber for heavy-duty or extra heavy-duty manual wheelchair, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $90.00 | $90.00 | $90.00 | |
Midlands
| Professional | $109.95 | $109.95 | $135.71 |