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Utah rates for HCPCS E2201

Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 in and less than 24 in

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.71 / $142.71 / $1,143.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.42 / $243.42 / $325.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.91 / $243.42 / $431.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.70 / $255.61 / $368.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.71 / $182.68 / $317.14