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Montana rates for HCPCS E0966

Manual Wheelchair Accessory Headrest Extension Each. (Rvsd 1/1/04)

Insurance Carrier
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.32 / $9.32 / $9.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $35.54 / $101.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $74.94 / $101.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $79.78 / $119.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.54 / $74.94 / $101.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.22 / $39.40 / $65.66