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Indiana 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
$595.82 / $595.82 / $595.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.33 / $595.82 / $622.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$722.12 / $818.10 / $914.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.22 / $699.76 / $923.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.41 / $724.51 / $1,278.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.70 / $719.85 / $1,193.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $763.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $1,151.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.08 / $476.91 / $729.03