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Montana rates for HCPCS E2626

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $588.84 / $891.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $645.65 / $954.99
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $954.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $691.83 / $891.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $616.60 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $295.12 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $363.08 / $416.87