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Alaska rates for HCPCS E2204

Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 in

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.02 / $1,178.02 / $1,178.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $581.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $598.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.97 / $532.78 / $795.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.41 / $805.54 / $1,130.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.20 / $902.84 / $2,255.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.51 / $539.61 / $786.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $598.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.09 / $1,062.00 / $1,939.31