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New Hampshire rates for HCPCS E2629

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.34 / $656.35 / $656.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,198.27 / $1,198.27 / $1,198.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.67 / $862.67 / $862.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.97 / $394.97 / $394.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.33 / $394.97 / $897.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.56 / $2,687.97 / $3,406.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.68 / $604.03 / $738.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.75 / $1,044.55 / $1,329.43