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New Hampshire rates for HCPCS E1222

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.93 / $522.40 / $522.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.79 / $534.79 / $534.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $70.28 / $659.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.49 / $415.16 / $552.41
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.40 / $700.69 / $891.79