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Wisconsin rates for HCPCS E2611

General Use Wheelchair Back Cushion Width Less Than 22 Inches Any Height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.47 / $150.47 / $150.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.12 / $123.06 / $189.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.50 / $323.05 / $323.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.05 / $177.47 / $247.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.06 / $125.11 / $603.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.72 / $126.72 / $479.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.72 / $207.75 / $259.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.00 / $300.93 / $432.58
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.88 / $249.88 / $451.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.47 / $376.16 / $908.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.99 / $202.91 / $312.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $252.38
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.00 / $300.93 / $432.58
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.88 / $249.88 / $451.39
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.43 / $41.18 / $53.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.72 / $378.79 / $908.34
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.72 / $126.72 / $169.65
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.08 / $290.08 / $290.08
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.08 / $290.08 / $290.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.55 / $164.24 / $312.35