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Ohio 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
$476.27 / $476.27 / $476.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.27 / $492.44 / $640.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$804.26 / $1,108.40 / $1,773.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.19 / $608.09 / $1,247.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.79 / $665.03 / $923.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.36 / $588.15 / $1,095.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $1,067.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.64 / $313.98 / $1,046.63
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $369.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.98 / $369.39 / $369.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.19 / $633.99 / $914.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.80 / $438.43 / $638.02