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Montana rates for HCPCS E1221

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

Insurance Carrier
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 / $598.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.83 / $181.71 / $480.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.24 / $407.81 / $598.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.23 / $279.33 / $465.56