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Indiana rates for HCPCS E2628

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.60 / $548.60 / $548.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.27 / $548.60 / $584.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.51 / $793.61 / $886.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.19 / $681.69 / $899.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.23 / $665.03 / $1,038.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.36 / $576.38 / $1,064.06
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 / $909.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.27 / $439.21 / $681.69