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Alaska rates for HCPCS E2628

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,193.84 / $1,193.84 / $1,193.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $369.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.64 / $369.39 / $380.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.58 / $640.58 / $859.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.82 / $842.99 / $1,178.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.27 / $985.07 / $2,106.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.58 / $640.58 / $859.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.64 / $369.39 / $380.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.11 / $1,077.38 / $2,057.67