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Pennsylvania rates for HCPCS E1028

Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.37 / $91.98 / $114.98
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.26 / $133.68 / $152.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.00 / $110.00 / $153.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.50 / $93.50 / $234.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.37 / $149.37 / $162.36
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.19 / $148.19 / $148.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.37 / $103.01 / $578.34
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.00 / $110.00 / $153.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.50 / $110.00 / $234.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.10 / $167.10 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.98 / $105.34 / $216.87