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Illinois rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.43 / $90.78 / $127.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.65 / $9.65 / $12.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.40 / $88.70 / $196.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.82 / $100.00 / $200.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.48 / $14.48 / $19.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $13.27 / $96.72