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Utah rates for HCPCS E1221

Wheelchair With Fixed Arm Footrests (Special Coverage Instructions Apply. See Cim: 60-6)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.71 / $181.71 / $181.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.81 / $407.81 / $407.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.24 / $407.81 / $652.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.71 / $279.33 / $366.02