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Utah rates for HCPCS E2205

Manual wheelchair accessory, handrim without projections (includes ergonomic or contoured), any type, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $30.90 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $26.92 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $26.92 / $48.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $29.51 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $41.69 / $46.77
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $5.01 / $41.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $13.18 / $28.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $19.50 / $36.31