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West Virginia 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
$461.92 / $539.61 / $622.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.77 / $554.03 / $738.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.80 / $583.13 / $795.54
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
$581.42 / $705.09 / $763.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.28 / $538.27 / $854.07