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Maine rates for HCPCS E1234

Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,613.52 / $1,613.52 / $2,913.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,685.46 / $1,685.46 / $1,984.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.78 / $1,208.78 / $2,629.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.49 / $1,208.78 / $1,890.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.79 / $2,197.79 / $2,197.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.08 / $1,613.52 / $2,913.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.66 / $1,320.86 / $2,412.96