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Idaho rates for HCPCS E1172

Amputee wheelchair, detachable arms (desk or full-length) without footrests or legrest

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,019.45 / $1,019.45 / $1,019.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.24 / $1,019.45 / $1,522.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.94 / $840.94 / $840.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.75 / $840.94 / $840.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.90 / $659.35 / $1,115.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.06 / $136.90 / $136.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.99 / $101.03 / $739.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.53 / $575.99 / $910.71