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Nebraska 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
$786.06 / $786.06 / $786.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.12 / $825.98 / $869.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $763.12 / $1,151.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.42 / $1,091.01 / $1,338.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.38 / $1,136.49 / $4,173.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.68 / $470.11 / $889.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.30 / $115.14 / $217.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.14 / $142.12 / $272.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.34 / $470.11 / $742.65