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Wisconsin rates for HCPCS E2625

Skin protection and positioning wheelchair seat cushion, adjustable, width 22 in or greater, any depth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.43 / $320.43 / $320.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.38 / $288.39 / $377.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.10 / $866.50 / $866.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.72 / $442.77 / $642.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.64 / $274.89 / $1,018.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.53 / $331.53 / $1,271.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.53 / $552.00 / $690.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.63 / $480.65 / $585.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.38 / $611.38 / $611.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.63 / $585.90 / $2,238.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.44 / $289.70 / $609.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $398.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.63 / $480.65 / $585.90
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.38 / $611.38 / $611.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.85 / $115.95 / $150.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.53 / $924.34 / $2,238.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.53 / $331.53 / $374.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.75 / $492.75 / $492.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.75 / $492.75 / $492.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.87 / $281.75 / $492.75