go back

Wisconsin 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
$590.79 / $590.79 / $590.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.65 / $557.49 / $698.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$886.70 / $1,613.79 / $1,613.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.63 / $824.65 / $1,197.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.78 / $478.42 / $1,897.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $2,741.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.98 / $1,046.63 / $1,308.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.58 / $834.58 / $1,063.44
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.08 / $1,064.08 / $1,064.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.58 / $1,063.44 / $4,343.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.01 / $511.27 / $1,088.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $247.80
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.79 / $886.20 / $1,063.44
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.08 / $1,064.08 / $1,064.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.04 / $205.88 / $267.32
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $1,731.88 / $4,343.22
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.39 / $369.39 / $369.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.72 / $886.72 / $886.72
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.72 / $886.72 / $886.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.85 / $439.21 / $886.72