| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.15 | $67.15 | $67.15 | |
Aetna
| Professional | $67.15 | $67.15 | $67.15 | |
Cigna
| Professional | $869.25 | $877.94 | $1,103.95 | |
Medica
| Facility | $58.88 | $67.15 | $200.43 |
Wheelchair accessory, wheelchair seat or back cushion, does not meet specific code criteria or no written coding verification from DME PDAC
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $67.15 | $67.15 | $67.15 | |
Aetna
| Professional | $67.15 | $67.15 | $67.15 | |
Cigna
| Professional | $869.25 | $877.94 | $1,103.95 | |
Medica
| Facility | $58.88 | $67.15 | $200.43 |