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Texas 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
$416.13 / $551.39 / $769.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.43 / $62.70 / $62.70
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.28 / $849.28 / $1,136.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.42 / $581.42 / $927.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $763.12
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,337.55 / $4,173.16 / $4,173.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $711.21 / $1,136.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.14 / $721.89 / $951.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.13 / $607.32 / $1,136.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.22 / $581.42 / $763.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.85 / $499.01 / $691.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.76 / $699.76 / $699.76