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Utah rates for HCPCS E0966

Manual Wheelchair Accessory Headrest Extension Each. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.30 / $27.30 / $243.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.54 / $35.54 / $74.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.22 / $35.54 / $103.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.17 / $58.34 / $84.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.30 / $39.40 / $60.66