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Utah rates for HCPCS K0195

Elevating Leg Rests Pair (For Use With Capped Rental Wheelchair Base) (Special Coverage Instructions Apply. See Cim: 60-9)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.43 / $80.59 / $80.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.70 / $88.70 / $98.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.41 / $75.40 / $196.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.18 / $11.18 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $11.63 / $118.20