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Montana rates for HCPCS E1011

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

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $424.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.00 / $424.00 / $436.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $574.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.00 / $424.00 / $436.72