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Wisconsin rates for HCPCS E2633

Wheelchair Accessory Addition To Mobile Arm Support Supinator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.04 / $111.04 / $111.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.75 / $98.08 / $128.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.40 / $304.67 / $304.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.68 / $155.69 / $225.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.18 / $91.36 / $358.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.53 / $70.53 / $495.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.95 / $189.38 / $236.72
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.87 / $159.34 / $199.87
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.15 / $203.15 / $203.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.87 / $199.87 / $802.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.58 / $97.61 / $203.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $121.03
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.04 / $166.56 / $199.87
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.15 / $203.15 / $203.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.10 / $39.44 / $51.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.53 / $325.06 / $802.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.53 / $70.53 / $70.53
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.29 / $169.29 / $169.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.29 / $169.29 / $169.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.45 / $94.47 / $199.23