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Idaho rates for HCPCS E2204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.22 / $727.22 / $727.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.78 / $727.22 / $1,038.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $732.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $705.09
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.12 / $567.37 / $1,038.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.93 / $801.10 / $877.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.23 / $752.33 / $772.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.11 / $852.11 / $1,506.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.61 / $451.46 / $813.40