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Pennsylvania rates for HCPCS E2368

Power Wheelchair Component Drive Wheel Motor Replacement Only (Revised 01/01/13)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.34 / $269.88 / $337.35
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.40 / $392.16 / $484.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.62 / $327.62 / $406.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.48 / $327.62 / $689.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.28 / $393.28 / $427.48
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.34 / $276.93 / $395.18
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.62 / $327.62 / $406.67
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.42 / $327.62 / $689.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.76 / $490.20 / $514.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.84 / $276.62 / $516.57