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Wisconsin rates for HCPCS E1004

Wheelchair accessory, power seating system, recline only, with mechanical shear reduction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,849.51 / $3,849.51 / $3,849.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,419.10 / $3,464.56 / $4,540.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,805.40 / $10,565.83 / $10,565.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,316.60 / $5,399.02 / $7,140.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$409.27 / $421.82 / $1,254.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,282.89 / $3,282.89 / $17,623.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,790.46 / $6,731.25 / $8,414.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.41 / $4,869.05 / $6,929.12
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,895.24 / $3,895.24 / $6,966.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.41 / $5,805.40 / $30,467.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,445.01 / $3,336.62 / $7,149.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $90.00 / $4,790.30
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.41 / $4,966.43 / $6,929.12
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,895.24 / $3,895.24 / $6,966.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.19 / $1,357.52 / $1,762.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,282.89 / $10,966.80 / $30,467.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.28 / $3,282.89 / $3,282.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,254.56 / $3,166.10 / $5,834.40