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North Carolina 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
$398.06 / $664.08 / $664.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $708.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $1,038.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.69 / $664.08 / $854.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.00 / $732.00 / $732.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.68 / $499.01 / $889.50
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,041.11 / $4,173.16 / $4,173.16