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Pennsylvania rates for HCPCS E1240

Lightweight Wheelchair Detachable Arms (Desk Or Full Length) Swing Away Detachable Elevating Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.45 / $678.84 / $822.12
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.21 / $1,162.89 / $1,292.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.83 / $200.00 / $1,987.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.45 / $678.84 / $882.56
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.81 / $200.00 / $1,987.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.80 / $1,229.80 / $1,370.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.35 / $633.92 / $1,180.32