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Utah rates for HCPCS E2369

Power Wheelchair Component Drive Wheel Gear Box Replacement Only (Revised 01/01/13)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.10 / $172.10 / $172.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.93 / $332.93 / $332.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.75 / $332.93 / $525.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.39 / $279.32 / $442.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.23 / $228.23 / $360.86