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Wisconsin rates for HCPCS E1011

Modification To Pediatric Size Wheelchair Width Adjustment Package (Not To Be Dispensed With Initial Chair)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $574.00 / $574.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.00 / $574.00 / $574.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.00 / $292.00 / $292.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.00 / $424.00 / $1,118.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.38 / $424.00 / $457.97
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $574.00 / $1,033.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $1,423.10 / $1,668.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $176.64
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.00 / $574.00 / $1,033.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $1,423.10 / $1,423.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.00 / $424.00 / $424.00