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Pennsylvania rates for HCPCS E1221

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.74 / $296.45 / $384.97
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.43 / $429.68 / $564.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.81 / $407.81 / $407.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.64 / $407.81 / $815.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.31 / $296.45 / $395.28
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.81 / $407.81 / $407.81
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.27 / $407.81 / $815.63
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.10 / $537.10 / $631.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.56 / $283.55 / $436.47