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Texas 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
Professional
Modifier
Low / Median / High Price
$564.19 / $702.57 / $947.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.08 / $339.63 / $391.72
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,215.70 / $1,215.70 / $1,215.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.73 / $746.73 / $746.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.22 / $746.73 / $746.73
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,980.48 / $5,455.13 / $5,654.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.94 / $332.82 / $902.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.15 / $121.57 / $955.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.33 / $332.82 / $809.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.92 / $746.73 / $746.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.89 / $477.48 / $670.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.00 / $660.00 / $737.77