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Washington 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 / $453.08 / $1,038.23
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $4,173.16 / $4,173.16
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.15 / $699.76 / $1,099.00
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 / $763.12
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.26 / $843.26 / $843.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.26 / $843.26 / $843.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.11 / $871.24 / $958.36
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.26 / $877.68 / $1,109.84
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.93 / $877.68 / $1,046.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.52 / $795.20 / $795.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.59 / $695.89 / $941.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.69 / $818.69 / $818.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.75 / $76.75 / $93.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.61 / $471.41 / $838.94
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.76 / $699.76 / $699.76