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Wisconsin rates for HCPCS E1297

Special Wheelchair Seat Depth By Upholstery (Special Coverage Instructions Apply. See Cim: 60-6)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.96 / $95.96 / $95.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.49 / $86.36 / $115.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $261.89 / $261.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.83 / $133.94 / $194.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.35 / $77.72 / $308.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.10 / $62.10 / $387.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.10 / $166.88 / $208.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.01 / $95.96 / $172.73
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.14 / $71.14 / $172.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.01 / $172.82 / $640.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.31 / $72.31 / $162.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $65.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.01 / $95.96 / $172.73
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.14 / $71.14 / $172.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.98 / $32.34 / $41.99
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.10 / $281.27 / $640.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.10 / $62.10 / $102.38
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.02 / $144.02 / $144.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.02 / $144.02 / $144.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.53 / $71.84 / $154.94