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Wisconsin rates for HCPCS E1012

Wheelchair Accessory Addition To Power Seating System Center Mount Power Elevating Leg Rest/ Platform Complete System Any Type Each Deleted 12/31/2004. Previously: Integrated Seating System Planar For Pediatric Wheelchair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.92 / $899.92 / $899.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.50 / $809.93 / $1,061.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,354.80 / $2,465.73 / $2,465.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.01 / $1,259.96 / $1,666.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.51 / $99.10 / $294.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.00 / $795.00 / $3,622.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.75 / $1,571.25 / $1,964.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.19 / $839.00 / $1,492.19
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.29 / $165.29 / $165.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.66 / $1,243.49 / $7,110.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.80 / $741.65 / $1,614.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $1,119.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.19 / $899.92 / $1,492.19
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.29 / $165.29 / $165.29
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.27 / $317.10 / $411.73
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.00 / $2,559.32 / $7,110.09
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.49 / $795.00 / $810.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.16 / $668.58 / $1,538.84