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Wisconsin rates for HCPCS E1180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.39 / $943.39 / $943.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.36 / $849.05 / $948.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.90 / $2,576.94 / $2,576.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.71 / $1,316.79 / $1,769.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.85 / $101.85 / $303.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.45 / $344.45 / $4,321.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.77 / $1,642.50 / $2,053.13
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.95 / $387.63 / $1,415.09
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.91 / $169.91 / $547.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.59 / $1,111.00 / $6,352.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.40 / $666.60 / $1,179.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.95 / $670.26 / $1,415.09
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.91 / $169.91 / $547.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.01 / $283.18 / $367.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.45 / $2,286.64 / $6,352.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.06 / $344.45 / $344.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.40 / $595.91 / $1,111.00