| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $32.02 | $35.22 | $38.11 | |
Cigna
| Facility | $37.90 | $37.90 | $37.90 | |
Cigna
| Professional | $32.22 | $32.22 | $49.76 | |
United
| Professional | $19.21 | $28.82 | $37.79 |
Power wheelchair accessory, foam drive wheel tire, any size, replacement only, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $32.02 | $35.22 | $38.11 | |
Cigna
| Facility | $37.90 | $37.90 | $37.90 | |
Cigna
| Professional | $32.22 | $32.22 | $49.76 | |
United
| Professional | $19.21 | $28.82 | $37.79 |