| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $336.05 | $336.05 | $336.05 | |
Aetna
| Professional | $336.05 | $336.05 | $336.05 | |
Cigna
| Professional | $750.00 | $757.50 | $952.50 | |
Medica
| Facility | $336.05 | $336.05 | $374.50 |
Custom fabricated wheelchair back cushion, any size, including any type mounting hardware
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $336.05 | $336.05 | $336.05 | |
Aetna
| Professional | $336.05 | $336.05 | $336.05 | |
Cigna
| Professional | $750.00 | $757.50 | $952.50 | |
Medica
| Facility | $336.05 | $336.05 | $374.50 |