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Wisconsin rates for HCPCS E2622

Skin Protection Wheelchair Seat Cushion Adjustablewidth Less Than 22 Inches Any Depth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.81 / $253.81 / $253.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.50 / $253.81 / $299.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.50 / $688.87 / $688.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.01 / $352.03 / $510.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.73 / $215.36 / $810.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.45 / $263.45 / $1,011.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.93 / $438.75 / $548.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.63 / $380.72 / $459.05
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.00 / $479.00 / $479.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.63 / $459.05 / $1,779.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.45 / $226.97 / $479.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $239.68
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.63 / $380.72 / $459.05
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.00 / $479.00 / $479.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.96 / $92.29 / $119.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.45 / $735.00 / $1,779.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.45 / $263.45 / $325.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.84 / $388.84 / $388.84
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.84 / $388.84 / $388.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.15 / $220.75 / $388.84