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Indiana rates for HCPCS E2201

Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 in and less than 24 in

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $208.93 / $269.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $346.74 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $380.19 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $457.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $575.44 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $245.47 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $158.49 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $223.87 / $331.13