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Utah rates for HCPCS E2627

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.69 / $497.69 / $3,455.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.66 / $542.66 / $542.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.14 / $542.66 / $1,327.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$561.24 / $814.70 / $1,176.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.20 / $561.16 / $904.89