| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $405.00 | $405.00 | $405.00 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $405.00 | $405.00 | $405.00 |