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Indiana 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
$851.14 / $851.14 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $776.25 / $851.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $741.31 / $1,148.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $831.76 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $457.09 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $524.81 / $812.83