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Wisconsin rates for HCPCS E1233

Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.55 / $2,062.55 / $2,062.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.50 / $1,856.30 / $2,439.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,095.70 / $5,634.17 / $5,634.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,321.77 / $2,879.00 / $3,869.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.71 / $222.71 / $662.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.76 / $1,406.76 / $9,451.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.75 / $3,588.75 / $4,485.93
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.01 / $1,506.70 / $3,093.83
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.48 / $371.48 / $1,772.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.53 / $2,429.40 / $13,890.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.76 / $1,517.23 / $2,985.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $58.40 / $3,095.70
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.01 / $1,994.16 / $3,093.83
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.48 / $371.48 / $1,772.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.66 / $619.21 / $804.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.76 / $5,000.14 / $13,890.95
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.80 / $1,406.76 / $1,406.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.50 / $1,457.64 / $2,538.55