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Pennsylvania 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
$320.45 / $461.92 / $622.58
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.42 / $671.15 / $804.17
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 / $1,297.97
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.84 / $739.84 / $804.17
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.91 / $562.91 / $677.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.45 / $461.92 / $829.66
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $763.12
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $1,297.97
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.54 / $838.94 / $916.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.33 / $517.39 / $880.18