| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $85.48 | $93.39 | $101.76 | |
Cigna
| Facility | $100.30 | $100.30 | $100.30 | |
Cigna
| Professional | $85.26 | $85.26 | $131.63 | |
United
| Professional | $51.29 | $76.93 | $113.91 |
Power wheelchair accessory, insert for pneumatic drive wheel tire (removable), any type, any size, replacement only, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $85.48 | $93.39 | $101.76 | |
Cigna
| Facility | $100.30 | $100.30 | $100.30 | |
Cigna
| Professional | $85.26 | $85.26 | $131.63 | |
United
| Professional | $51.29 | $76.93 | $113.91 |