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Washington rates for HCPCS E1200

Amputee wheelchair, fixed full-length arms, swing-away detachable footrest

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.65 / $607.67 / $814.32
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.45 / $5,455.13 / $5,455.13
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.00 / $799.75 / $1,276.49
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 / $634.72 / $746.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $121.57 / $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
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.45 / $106.45 / $106.45
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,009.12 / $1,214.96 / $1,365.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.09 / $82.09 / $99.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.27 / $511.68 / $852.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.67 / $631.67 / $631.67