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Wisconsin rates for HCPCS E0995

Wheelchair accessory, calf rest/pad, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.19 / $22.19 / $22.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.95 / $19.97 / $24.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.50 / $59.15 / $59.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.24 / $43.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $19.72 / $69.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.85 / $21.85 / $31.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.85 / $37.88 / $47.34
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.63 / $29.28 / $42.09
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.32 / $24.32 / $43.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.63 / $39.94 / $155.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.27 / $20.25 / $40.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.66 / $50.00 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.63 / $29.28 / $42.09
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.32 / $24.32 / $43.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.29 / $7.10 / $9.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.85 / $63.14 / $155.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.85 / $21.85 / $28.68
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.56 / $34.56 / $34.56
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.56 / $34.56 / $34.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.21 / $19.75 / $38.81