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Illinois rates for HCPCS E1011

Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.00 / $574.00 / $574.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.75 / $42.75 / $42.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $424.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.97 / $424.00 / $436.72
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $200.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00