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Pennsylvania 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
$346.03 / $492.44 / $640.58
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.42 / $731.34 / $914.17
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 / $313.98 / $1,046.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.04 / $841.04 / $914.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.65 / $492.44 / $705.45
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $369.39
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.64 / $369.39 / $1,308.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.85 / $894.50 / $894.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.85 / $506.53 / $867.83