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Indiana rates for HCPCS E2369

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.20 / $309.20 / $309.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.86 / $306.41 / $310.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.02 / $344.42 / $384.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.00 / $398.89 / $506.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.94 / $56.91 / $635.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.22 / $58.85 / $666.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.93 / $332.93 / $332.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.75 / $332.93 / $447.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.15 / $237.13 / $382.45