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Oregon rates for HCPCS E1011

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $574.00 / $574.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.00 / $574.00 / $574.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $424.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.40 / $424.00 / $424.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $574.00 / $786.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.74 / $190.74 / $79,999.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.74 / $190.74 / $190.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $574.00 / $786.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.40 / $424.00 / $2,400,000.00