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Wisconsin rates for HCPCS E1224

Wheelchair With Detachable Arms Elevating Legrests (Special Coverage Instructions Apply. See Cim: 60-6)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.11 / $642.11 / $642.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.02 / $593.65 / $893.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.80 / $1,754.12 / $1,754.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.49 / $896.33 / $1,185.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.33 / $69.33 / $206.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.20 / $428.20 / $2,938.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.97 / $1,117.50 / $1,396.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.36 / $310.41 / $1,067.58
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.66 / $115.66 / $438.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.38 / $889.66 / $5,087.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.27 / $531.78 / $944.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.36 / $536.90 / $1,067.58
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.66 / $115.66 / $438.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.24 / $226.39 / $293.95
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.20 / $1,831.10 / $5,087.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.83 / $428.20 / $428.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.27 / $533.79 / $944.53