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Washington rates for HCPCS E1171

Amputee Wheelchair Fixed Full Length Arms Without Footrests Or Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.79 / $559.90 / $771.03
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $5,025.03 / $5,025.03
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.96 / $621.79 / $1,175.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.90 / $687.90 / $687.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.10 / $584.72 / $687.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $111.98 / $111.98
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.45 / $1,875.50 / $1,902.13
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,561.45 / $1,875.50 / $1,902.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.06 / $98.06 / $98.06
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.96 / $1,000.21 / $1,257.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.62 / $75.62 / $92.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.00 / $471.40 / $785.67
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.00 / $582.00 / $582.00