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Virginia 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
$544.26 / $544.26 / $544.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.97 / $544.26 / $705.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$904.85 / $904.85 / $904.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.69 / $681.69 / $681.69
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 / $797.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.70 / $777.04 / $1,060.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.07 / $640.58 / $963.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.34 / $802.34 / $802.34
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.06 / $103.97 / $794.29
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.06 / $103.97 / $794.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.01 / $476.57 / $681.69