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Utah rates for HCPCS E2626

Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $575.44 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $275.42 / $891.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $512.86 / $741.31
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $794.33 / $870.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $95.50 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $251.19 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $363.08 / $707.95