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Texas rates for HCPCS E1172

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.30 / $791.14 / $1,066.83
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,369.00 / $1,369.00 / $1,369.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.94 / $840.94 / $840.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.59 / $840.94 / $840.94
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,230.44 / $6,143.69 / $6,367.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.14 / $374.67 / $1,038.71
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.12 / $136.90 / $973.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.37 / $374.67 / $911.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.75 / $840.94 / $840.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.42 / $537.13 / $754.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.01 / $743.01 / $829.18