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Utah rates for HCPCS E1171

Amputee Wheelchair Fixed Full Length Arms Without Footrests Or Legrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.58 / $306.58 / $306.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.90 / $687.90 / $687.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.87 / $687.90 / $1,188.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.20 / $471.40 / $617.39