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Utah rates for HCPCS E1011

Modification to pediatric size wheelchair, width adjustment package (not to be dispensed with initial chair)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $426.58 / $436.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26