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Wisconsin rates for HCPCS E2377

Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, upgrade provided at initial issue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.71 / $374.71 / $374.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.48 / $337.24 / $441.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$560.40 / $1,019.93 / $1,019.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.61 / $521.16 / $700.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.50 / $42.05 / $125.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.36 / $279.36 / $1,495.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.46 / $648.75 / $810.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.28 / $489.60 / $672.48
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.57 / $388.57 / $672.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.28 / $562.07 / $3,065.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.90 / $336.91 / $696.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $90.00 / $466.30
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.28 / $489.60 / $672.48
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.57 / $388.57 / $672.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.56 / $136.46 / $177.19
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.36 / $794.50 / $3,065.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.04 / $279.36 / $382.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.00 / $324.80 / $696.00