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Utah rates for HCPCS E1295

Heavy-duty wheelchair, fixed full-length arms, elevating legrest

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,288.25 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $1,047.13 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $870.96 / $1,047.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,479.11 / $1,737.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $147.91 / $208.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $489.78 / $1,122.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $707.95 / $1,288.25