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Montana rates for HCPCS E1295

Heavy Duty Wheelchair Fixed Full Length Arms Elevating Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.44 / $1,042.44 / $1,042.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.94 / $1,042.44 / $1,530.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.82 / $464.63 / $1,229.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.94 / $1,042.44 / $1,530.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.79 / $714.14 / $1,190.24