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Pennsylvania rates for HCPCS E1172

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.89 / $647.22 / $781.80
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.40 / $1,242.90 / $1,242.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.94 / $840.94 / $840.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.80 / $840.94 / $1,982.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.26 / $652.98 / $764.18
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.94 / $840.94 / $840.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.59 / $840.94 / $1,982.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.59 / $1,183.00 / $1,303.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.93 / $584.67 / $900.18