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Utah rates for HCPCS E2394

Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $52.48 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $45.71 / $79.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $44.67 / $64.57
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $69.18 / $85.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $8.32 / $69.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $27.54 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $36.31 / $64.57