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Wisconsin rates for HCPCS E2631

Wheelchair accessory, addition to mobile arm support, elevating proximal arm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.02 / $223.02 / $223.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.11 / $184.88 / $247.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.39 / $594.04 / $594.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.52 / $303.55 / $440.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.55 / $199.24 / $698.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.43 / $244.43 / $940.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.43 / $358.88 / $448.59
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.97 / $295.44 / $424.70
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.16 / $443.16 / $443.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.97 / $424.70 / $1,550.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.72 / $180.99 / $400.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $221.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.02 / $334.53 / $424.70
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.16 / $443.16 / $443.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.08 / $72.56 / $94.23
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.43 / $633.74 / $1,550.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.77 / $244.43 / $244.43
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.64 / $362.64 / $362.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.64 / $362.64 / $362.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.98 / $177.84 / $400.23