| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $375.44 | $375.44 | $375.44 | |
Aetna
| Professional | $375.44 | $412.99 | $412.99 | |
Medica
| Facility | $90.00 | $375.44 | $446.74 |
Back, contoured, for pediatric size wheelchair including fixed attaching hardware
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $375.44 | $375.44 | $375.44 | |
Aetna
| Professional | $375.44 | $412.99 | $412.99 | |
Medica
| Facility | $90.00 | $375.44 | $446.74 |