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Wisconsin rates for HCPCS E0967

Manual Wheelchair Accessory Hand Rim With Projections Any Type Replacement Only Each (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.78 / $58.78 / $58.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.44 / $52.96 / $68.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.90 / $159.97 / $159.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.73 / $81.75 / $118.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.19 / $61.96 / $196.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.33 / $44.33 / $235.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.68 / $102.00 / $127.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.13 / $73.41 / $105.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.55 / $52.55 / $110.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.13 / $110.11 / $407.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.97 / $49.99 / $107.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.49 / $54.15 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.13 / $73.41 / $105.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.55 / $52.55 / $110.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.60 / $19.72 / $25.61
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.33 / $170.66 / $407.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.68 / $44.33 / $67.81
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.77 / $91.77 / $91.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.77 / $91.77 / $91.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.97 / $44.98 / $105.47