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Oregon rates for HCPCS E1200

Amputee Wheelchair Fixed Full Length Arms Swing Away Detachable Footrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.20 / $905.20 / $905.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$607.67 / $607.67 / $905.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.73 / $746.73 / $746.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.92 / $634.72 / $746.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,623.01 / $2,675.71 / $2,902.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.50 / $451.01 / $1,297.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.36 / $95.93 / $121.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.10 / $2,036.03 / $2,064.94
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,695.10 / $2,036.03 / $2,064.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.09 / $332.82 / $1,297.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.93 / $115.71 / $746.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.27 / $511.68 / $852.80