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Indiana rates for HCPCS E1221

Wheelchair With Fixed Arm Footrests (Special Coverage Instructions Apply. See Cim: 60-6)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.12 / $349.12 / $349.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.12 / $356.57 / $397.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.66 / $360.42 / $450.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.47 / $73.36 / $743.99
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $67.72 / $892.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.81 / $407.81 / $407.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.24 / $407.81 / $481.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.22 / $254.20 / $395.06