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Illinois 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
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $776.25 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $831.76 / $1,584.89
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $199.53 / $199.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $331.13 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $588.84 / $933.25