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Ohio 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
$488.10 / $488.10 / $488.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.92 / $488.10 / $829.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.07 / $1,142.59 / $1,828.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.39 / $691.50 / $1,188.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.25 / $685.56 / $1,136.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.70 / $660.39 / $1,193.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $1,144.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $1,038.38
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $763.12
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.42 / $581.42 / $763.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.04 / $812.56 / $1,171.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.94 / $476.91 / $725.24