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Utah rates for HCPCS E2628

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.93 / $374.93 / $2,634.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.39 / $369.39 / $369.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.64 / $369.39 / $1,046.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.99 / $627.09 / $905.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.76 / $435.42 / $681.69