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Pennsylvania rates for HCPCS E1030

Wheelchair accessory, ventilator tray, gimbaled

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.46 / $737.28 / $921.60
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.33 / $1,068.56 / $1,403.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.51 / $606.51 / $606.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.53 / $606.51 / $2,034.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.46 / $753.72 / $1,165.26
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.51 / $606.51 / $606.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.23 / $606.51 / $2,034.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.28 / $1,335.70 / $1,335.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.95 / $734.12 / $1,260.94