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Wisconsin rates for HCPCS E1150

Wheelchair Detachable Arms Desk Or Full Length Swing Away Detachable Elevating Legrests (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.36 / $759.36 / $759.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.91 / $641.78 / $782.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.70 / $2,074.25 / $2,074.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.75 / $1,059.92 / $1,424.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.00 / $82.00 / $243.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.00 / $134.00 / $3,266.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.90 / $1,241.25 / $1,551.56
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $312.02 / $1,139.04
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.76 / $136.76 / $440.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.03 / $924.69 / $5,113.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.03 / $489.57 / $949.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.38 / $539.72 / $1,139.04
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.76 / $136.76 / $440.91
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.00 / $227.96 / $295.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.00 / $1,840.64 / $5,113.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.23 / $134.00 / $134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.03 / $536.59 / $934.49