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Utah rates for HCPCS E2203

Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22 in

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $389.05 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $331.13 / $575.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $346.74 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $512.86 / $616.60
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $61.66 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $181.97 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $251.19 / $416.87