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Michigan 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
$1,042.40 / $1,042.40 / $1,042.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.02 / $1,042.40 / $1,090.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,953.68 / $5,271.56 / $6,903.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.04 / $1,365.58 / $1,940.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.98 / $75.64 / $729.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.52 / $109.52 / $1,604.28
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 / $1,586.25
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.81 / $738.09 / $1,369.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.15 / $525.44 / $762.61