| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $59.28 | $59.28 | $59.28 | |
Aetna
| Professional | $59.28 | $59.28 | $59.28 | |
Medica
| Facility | $59.28 | $59.28 | $80.00 |
Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating frame, allows coordinated movement of multiple positioning features
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $59.28 | $59.28 | $59.28 | |
Aetna
| Professional | $59.28 | $59.28 | $59.28 | |
Medica
| Facility | $59.28 | $59.28 | $80.00 |