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Virginia rates for HCPCS E2375

Power wheelchair accessory, nonexpandable controller, including all related electronics and mounting hardware, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.30 / $492.30 / $492.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.21 / $492.30 / $658.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$747.30 / $747.30 / $747.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.41 / $649.41 / $649.41
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.05 / $674.05 / $674.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.96 / $407.96 / $590.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.77 / $407.96 / $420.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.22 / $579.86 / $766.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.12 / $371.21 / $796.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.39 / $899.39 / $899.39
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.79 / $359.00 / $925.08
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.51 / $107.06 / $898.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.92 / $436.85 / $685.25