| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $94.50 | $94.50 | $94.50 | |
Cigna
| Professional | $94.50 | $94.50 | $150.55 | |
Providence
| Facility | $94.50 | $94.50 | $94.50 | |
Providence
| Professional | $94.50 | $94.50 | $150.55 |
Heavy-duty shock absorber for heavy-duty or extra heavy-duty power wheelchair, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $94.50 | $94.50 | $94.50 | |
Cigna
| Professional | $94.50 | $94.50 | $150.55 | |
Providence
| Facility | $94.50 | $94.50 | $94.50 | |
Providence
| Professional | $94.50 | $94.50 | $150.55 |