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Utah rates for HCPCS E1200

Amputee Wheelchair Fixed Full Length Arms Swing Away Detachable Footrest (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.82 / $332.82 / $332.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.73 / $746.73 / $746.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.92 / $746.73 / $1,196.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.77 / $511.68 / $670.33