| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.77 | $19.55 | $21.15 | |
Cigna
| Facility | $21.16 | $21.16 | $21.16 | |
Cigna
| Professional | $17.98 | $17.98 | $27.78 | |
United
| Professional | $10.66 | $15.99 | $23.26 |
Power wheelchair accessory, foam caster tire, any size, replacement only, each
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $17.77 | $19.55 | $21.15 | |
Cigna
| Facility | $21.16 | $21.16 | $21.16 | |
Cigna
| Professional | $17.98 | $17.98 | $27.78 | |
United
| Professional | $10.66 | $15.99 | $23.26 |