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Utah rates for HCPCS E1190

Amputee wheelchair, detachable arms (desk or full-length) swing-away detachable elevating legrests

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.80 / $447.80 / $447.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.61 / $1,140.20 / $2,371.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.89 / $688.37 / $901.90