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Utah rates for HCPCS E1195

Heavy-duty wheelchair, fixed full-length arms, swing-away detachable elevating legrests

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $1,318.26 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $1,230.27 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,513.56 / $1,778.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $151.36 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $512.86 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $741.31 / $1,348.96